MEDICARE: PHYSICIANS SURGICAL CENTER OF FT. WORTH LLP

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	130267	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578530226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS SURGICAL CENTER OF FT. WORTH LLP

Provider Business Mailing Address
First Line	:	750 12TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2531
Country	:	US
Telephone Number	:	817-529-2620
Fax Number	:	817-877-1292

Provider Business Practice Location Address
First Line	:	750 12TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2531
Country	:	US
Telephone Number	:	817-529-2620
Fax Number	:	817-877-1292

Authorized Official
Title or Position	:	MEDICARE AUTHORIZED OFFICIAL
Name	:	DONITA FLEMING
Credential	:
Telephone Number	:	202-815-3665

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	02/09/2026

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