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General NPI Number Information
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NPI Number | 1821471640
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Entity Type | Organization
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Legal Business Name | WATERMERE SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 2815 W SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6726
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Country | US
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Telephone | 817-431-3200
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Fax | 817-431-3117
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Provider Business Mailing Address
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Address Line | 1000 LIPSCOMB ST STE 110
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City | FORT WORTH
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State | TX
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Zip | 76104-3181
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | VED V. AGGARWAL
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Credential | MD
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Telephone | 972-849-8216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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