MEDICARE: DESOTO SURGICARE PARTNERS, LTD

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	000354	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	490003162	OTHER	TN	RAILROAD MEDICARE

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	:	1609870336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOTO SURGICARE PARTNERS, LTD

Provider Business Mailing Address
First Line	:	7992 W VIRGINIA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3764
Country	:	US
Telephone Number	:	972-283-2400
Fax Number	:	972-283-0099

Provider Business Practice Location Address
First Line	:	7992 W VIRGINIA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3764
Country	:	US
Telephone Number	:	972-283-2400
Fax Number	:	972-283-0099

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/16/2025

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Directions to “DESOTO SURGICARE PARTNERS, LTD ” Practice Location

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