Provider Demographics
NPI:1174258107
Name:FW SPECIALTY SURGICARE, LLC
Entity Type:Organization
Organization Name:FW SPECIALTY SURGICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:682-800-1099
Mailing Address - Street 1:2001 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2529
Mailing Address - Country:US
Mailing Address - Phone:817-339-6991
Mailing Address - Fax:817-678-4601
Practice Address - Street 1:2001 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2529
Practice Address - Country:US
Practice Address - Phone:817-339-6991
Practice Address - Fax:817-678-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty