Provider Demographics
NPI:1700419678
Name:METHODIST MANSFIELD AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:METHODIST MANSFIELD AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:252 MATLOCK RD STE 430
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6565
Mailing Address - Country:US
Mailing Address - Phone:817-242-3600
Mailing Address - Fax:817-242-3601
Practice Address - Street 1:252 MATLOCK RD STE 430
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6565
Practice Address - Country:US
Practice Address - Phone:817-242-3600
Practice Address - Fax:817-242-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical