Basic Information
| Provider Information | |||||||||
| NPI: | 1679503858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWSC-HURST, L.P. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHWEST SURGICAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 HURST TOWN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760546236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173454100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1612 HURST TOWN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760546236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173454100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 04/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | WIIG | ||||||||
| AuthorizedOfficialFirstName: | TRUDY | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8173454100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | 008123 | TX | Y | Hospitals | Special Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1722621-01 | 05 | TX | MEDICAID |