1316991938 NPI number — SURGICAL AND DIAGNOSTIC CENTER, L.P.

Table of content: (NPI 1316991938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316991938 NPI number — SURGICAL AND DIAGNOSTIC CENTER, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL AND DIAGNOSTIC CENTER, L.P.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316991938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
729 BEDFORD-EULESS ROAD WEST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-282-1001
Provider Business Mailing Address Fax Number:
817-282-4040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 BEDFORD-EULESS ROAD WEST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-282-1001
Provider Business Practice Location Address Fax Number:
817-282-4040
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
817-868-1109

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  007186 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181558400 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0000HH1326 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109488002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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