Basic Information
| Provider Information | |||||||||
| NPI: | 1962143636 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 SUMMIT AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173326092 | ||||||||
| FaxNumber: | 8173326015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 SUMMIT AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173326092 | ||||||||
| FaxNumber: | 8173326015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2022 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | TAMI | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8176924089 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.