MEDICARE: DAVAC 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	:	1538046735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVAC LLC

Provider Business Mailing Address
First Line	:	919 TRAVIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3137
Country	:	US
Telephone Number	:	817-810-0700
Fax Number	:	817-810-0712

Provider Business Practice Location Address
First Line	:	919 TRAVIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3137
Country	:	US
Telephone Number	:	817-810-0700
Fax Number	:	817-810-0712

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	LEIGH ANN RAY
Credential	:
Telephone Number	:	502-572-6353

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	08/19/2025

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Directions to “DAVAC LLC ” Practice Location

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