Provider Demographics
NPI:1912139056
Name:ALLIED CENTER FOR SPECIAL SURGERY DFW LLC
Entity Type:Organization
Organization Name:ALLIED CENTER FOR SPECIAL SURGERY DFW LLC
Other - Org Name:ST. MICHAEL'S CENTER FOR SPECIAL SURGERY, DFW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-586-6705
Mailing Address - Street 1:PO BOX 924587
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-4587
Mailing Address - Country:US
Mailing Address - Phone:713-586-6705
Mailing Address - Fax:713-586-6752
Practice Address - Street 1:1605 AIRPORT FREEWAY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-267-2300
Practice Address - Fax:817-267-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical