MEDICARE: NORTHSTAR VASCULAR SURGERY CENTER OF TEXAS, 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	2086S0129X	Vascular Surgery Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1275421158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR VASCULAR SURGERY CENTER OF TEXAS, LLC

Provider Business Mailing Address
First Line	:	1902 WINDSOR PL STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1866
Country	:	US
Telephone Number	:	682-207-1700
Fax Number	:	682-250-5246

Provider Business Practice Location Address
First Line	:	5901 S. HULEN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2687
Country	:	US
Telephone Number	:	817-714-8262
Fax Number	:	682-241-1922

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	OLADAPO AFOLABI
Credential	:	MD
Telephone Number	:	682-207-1700

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	03/11/2026

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