Provider Demographics
NPI:1942690342
Name:FIDELITY SURGICAL SUITES LLC
Entity Type:Organization
Organization Name:FIDELITY SURGICAL SUITES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:972-743-2126
Mailing Address - Street 1:PO BOX 542618
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-2618
Mailing Address - Country:US
Mailing Address - Phone:972-743-2126
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:591 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3628
Practice Address - Country:US
Practice Address - Phone:972-743-2126
Practice Address - Fax:888-770-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000387261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical