Provider Demographics
NPI:1316197866
Name:SWSC-HURST PHYSICIANSS, INC
Entity Type:Organization
Organization Name:SWSC-HURST PHYSICIANSS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-345-4100
Mailing Address - Street 1:1612 HURST TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-6236
Mailing Address - Country:US
Mailing Address - Phone:817-345-4100
Mailing Address - Fax:817-345-4089
Practice Address - Street 1:1612 HURST TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-6236
Practice Address - Country:US
Practice Address - Phone:817-345-4100
Practice Address - Fax:817-345-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535207251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX535207OtherTEXAS MEDICAL BOARD