Provider Demographics
NPI:1346576790
Name:SOUTHWESTERN WOMEN'S SURGERY CENTER
Entity Type:Organization
Organization Name:SOUTHWESTERN WOMEN'S SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-742-9310
Mailing Address - Street 1:8616 GREENVILLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7146
Mailing Address - Country:US
Mailing Address - Phone:214-742-9310
Mailing Address - Fax:214-969-9468
Practice Address - Street 1:8616 GREENVILLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7146
Practice Address - Country:US
Practice Address - Phone:214-742-9310
Practice Address - Fax:214-969-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130019261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical