Organization
TEXAS SURGICAL ALLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JAMIE BURK LSA (OWNER)
(832) 457-8868
Entity
Organization
Contact information
Practice address
6677 FRIENDSWAY DR, FORT WORTH, TX 76137
(832) 457-8868
Mailing address
6677 FRIENDSWAY DR, FORT WORTH, TX 76137-7541
(832) 457-8868
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00468
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089YL
BCBS
TX
Enumeration date
06/08/2017
Last updated
07/21/2022
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