Organization
PSN FW HOLDCO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN FOWLER (CEO)
(917) 216-6285
Entity
Organization
Contact information
Practice address
975 HASKELL STREET, FORT WORTH, TX 76107
(817) 945-8000
(817) 945-9679
Mailing address
1900 ENCHANTED WAY SUITE 100, GRAPEVINE, TX 76051
(682) 223-5552
(682) 223-5560
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
TX
Other
Enumeration date
02/14/2018
Last updated
02/28/2019
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