Provider Demographics
NPI:1538104724
Name:FORT WORTH ENDOSCOPY CENTERS, LLC
Entity Type:Organization
Organization Name:FORT WORTH ENDOSCOPY CENTERS, LLC
Other - Org Name:SOUTHWEST FORT WORTH ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:6445 HARRIS PKWY
Mailing Address - Street 2:STE 150
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6445 HARRIS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4140
Practice Address - Country:US
Practice Address - Phone:817-423-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC152Medicare PIN