Provider Demographics
NPI:1790945145
Name:MANSFIELD SURGICAL PLAZA LLC
Entity Type:Organization
Organization Name:MANSFIELD SURGICAL PLAZA LLC
Other - Org Name:MANSFIELD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-453-2744
Mailing Address - Street 1:280 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7823
Mailing Address - Country:US
Mailing Address - Phone:817-453-2744
Mailing Address - Fax:817-842-0007
Practice Address - Street 1:280 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7823
Practice Address - Country:US
Practice Address - Phone:817-453-2744
Practice Address - Fax:817-842-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008706261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC382Medicare PIN