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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