MEDICARE: IDC OPERATIONS, LP

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	PENDING SURVEY	TX

General Provider Information

NPI Number	:	1326088832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDC OPERATIONS, LP

Provider Business Mailing Address
First Line	:	905 EUREKA ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5809
Country	:	US
Telephone Number	:	817-598-8100
Fax Number	:	817-598-8101

Provider Business Practice Location Address
First Line	:	905 E. EUREKA ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5809
Country	:	US
Telephone Number	:	817-598-8100
Fax Number	:	817-598-8101

Authorized Official
Title or Position	:	OWNER / CFO
Name	:	MR. MICHAEL J. KWEDAR
Credential	:
Telephone Number	:	817-921-2667

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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