Provider Demographics
NPI:1629381967
Name:WEST MAGNOLIA SURGERY CENTER
Entity Type:Organization
Organization Name:WEST MAGNOLIA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:BLACKBURN
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-870-4833
Mailing Address - Street 1:1200 W MAGNOLIA AVE
Mailing Address - Street 2:110
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4481
Mailing Address - Country:US
Mailing Address - Phone:817-870-4833
Mailing Address - Fax:817-870-4893
Practice Address - Street 1:1200 W MAGNOLIA AVE
Practice Address - Street 2:110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4481
Practice Address - Country:US
Practice Address - Phone:817-870-4833
Practice Address - Fax:817-870-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical