Provider Demographics
NPI:1093120859
Name:PARK HILL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PARK HILL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-773-0293
Mailing Address - Street 1:3455 LOCKE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5745
Mailing Address - Country:US
Mailing Address - Phone:817-585-1900
Mailing Address - Fax:817-585-1899
Practice Address - Street 1:3455 LOCKE AVE
Practice Address - Street 2:STE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5745
Practice Address - Country:US
Practice Address - Phone:817-585-1900
Practice Address - Fax:817-585-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical