MEDICARE: NORTH TEXAS SURGICENTER

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	:	1336184340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS SURGICENTER

Provider Business Mailing Address
First Line	:	917 MIDWESTERN PKWY
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 MIDWESTERN PKWY
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2209
Country	:	US
Telephone Number	:	940-767-7273
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY WOOD
Credential	:
Telephone Number	:	828-236-3027

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/31/2007

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