Provider Demographics
NPI:1326088832
Name:IDC OPERATIONS, LP
Entity Type:Organization
Organization Name:IDC OPERATIONS, LP
Other - Org Name:SURGERY CENTER AT PARK CITY MEDICAL COMPLEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KWEDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-921-2667
Mailing Address - Street 1:905 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5809
Mailing Address - Country:US
Mailing Address - Phone:817-598-8100
Mailing Address - Fax:817-598-8101
Practice Address - Street 1:905 E. EUREKA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5809
Practice Address - Country:US
Practice Address - Phone:817-598-8100
Practice Address - Fax:817-598-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING SURVEY261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical