MEDICARE: BAYLOR SURGICARE AT MANSFIELD, 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	130056	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00847625	OTHER	TX	RAILROAD MEDICARE PTAN

General Provider Information

NPI Number	:	1992037352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYLOR SURGICARE AT MANSFIELD, LLC

Provider Business Mailing Address
First Line	:	280 REGENCY PKWY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7823
Country	:	US
Telephone Number	:	817-453-2744
Fax Number	:	817-842-0007

Provider Business Practice Location Address
First Line	:	280 REGENCY PKWY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7823
Country	:	US
Telephone Number	:	817-453-2744
Fax Number	:	817-842-0007

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	PETER BLACH
Credential	:
Telephone Number	:	713-343-0832

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	11/21/2025

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