Provider Demographics
NPI:1639397326
Name:FORT WORTH PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:FORT WORTH PLASTIC SURGERY CENTER
Other - Org Name:TEXAS SURGICARE LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-810-0600
Mailing Address - Street 1:800 12TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2519
Mailing Address - Country:US
Mailing Address - Phone:817-810-0600
Mailing Address - Fax:817-348-8951
Practice Address - Street 1:800 12TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2519
Practice Address - Country:US
Practice Address - Phone:817-810-0600
Practice Address - Fax:817-348-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty