Provider Demographics
NPI:1902844426
Name:SOUTH ARLINGTON SURGICAL PROVIDERS, LLC
Entity Type:Organization
Organization Name:SOUTH ARLINGTON SURGICAL PROVIDERS, LLC
Other - Org Name:SAME DAY SURGICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-784-6771
Mailing Address - Street 1:350 E INTERSTATE 20 STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1119
Mailing Address - Country:US
Mailing Address - Phone:817-784-6771
Mailing Address - Fax:817-784-6743
Practice Address - Street 1:350 E INTERSTATE 20 STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1119
Practice Address - Country:US
Practice Address - Phone:817-784-6771
Practice Address - Fax:817-784-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000391261QA1903X
TX130217261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087953817Medicaid
TX087953801Medicaid
TXASC026Medicare PIN