MEDICARE: MEDICAL CITY SURGERY CENTER OF ALLIANCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1164017778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CITY SURGERY CENTER OF ALLIANCE, LLC

Provider Business Mailing Address
First Line	:	8900 MEDICAL CITY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 MEDICAL CITY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2474
Country	:	US
Telephone Number	:	817-898-6610
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM G SWINNEY
Credential	:
Telephone Number	:	972-289-2877

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/05/2021

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