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Organization
TARRANT COUNTY SURGICAL CENTER LLC
Active
Organization
TARRANT COUNTY SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAI L GALLOP (ADMINISTRATOR)
(817) 348-8600
Entity
Organization
Contact information
Practice address
914 LIPSCOMB ST, FORT WORTH, TX 76104-3169
(817) 348-8600
Mailing address
914 LIPSCOMB ST, FORT WORTH, TX 76104-3169
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
PENDING
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130023
TEXAS STATE LICENSE
TX
01
—
HH199A
BLUE CROS BLUE SHEILD
TX
Enumeration date
02/05/2009
Last updated
11/25/2009
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