Organization
GRAPEVINE SURGICARE PARTNERS LTD
Active
Other names
Baylor Scott & White Surgicare - Southlake
Organization subpart
No
Provider details
NPI number
Authorized official
DONITA FLEMING (AUTHORIZED OFFICIAL)
(202) 815-3665
Entity
Organization
Contact information
Practice address
905 E SOUTHLAKE BLVD, STE 200, SOUTHLAKE, TX 76092-8602
(817) 410-4300
(817) 410-4303
Mailing address
905 E SOUTHLAKE BLVE, STE 200, SOUTHLAKE, TX 76092-8602
(817) 410-4300
(817) 410-4303
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
007819
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173382601
—
TX
01
—
490005386
RAILROAD MEDICARE
TX
Enumeration date
03/01/2006
Last updated
10/07/2024
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