Provider Demographics
NPI:1902850571
Name:SDM ASC LLC
Entity Type:Organization
Organization Name:SDM ASC LLC
Other - Org Name:DAYTIME OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-738-3390
Mailing Address - Street 1:6311 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1063
Mailing Address - Country:US
Mailing Address - Phone:817-738-3390
Mailing Address - Fax:817-731-4282
Practice Address - Street 1:6311 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1063
Practice Address - Country:US
Practice Address - Phone:817-738-3390
Practice Address - Fax:817-731-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007141261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7418670OtherAETNA
181326700OtherDEPARTMENT OF LABOR
TXHH048AOtherBCBS
181326700OtherDEPARTMENT OF LABOR