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Organization
SURGICAL AND DIAGNOSTIC CENTER, L.P.
Active
Organization
SURGICAL AND DIAGNOSTIC CENTER, L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERT SHAW MD (MEDICAL DIRECTOR)
(817) 868-1109
Entity
Organization
Contact information
Practice address
729 BEDFORD-EULESS ROAD WEST, SUITE 100, HURST, TX 76053
(817) 282-1001
(817) 282-4040
Mailing address
729 BEDFORD-EULESS ROAD WEST, SUITE 100, HURST, TX 76053
(817) 282-1001
(817) 282-4040
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
007186
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000HH1326
BLUE CROSS BLUE SHIELD
TX
05
—
109488002
—
TX
01
—
181558400
US DEPARTMENT OF LABOR
TX
Enumeration date
05/19/2006
Last updated
10/01/2009
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