Organization
SDM ASC LLC
Active
Other names
Daytime Outpatient Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
PAM MONAGHAN RN (ADMINISTRATOR)
(817) 738-3390
Entity
Organization
Contact information
Practice address
6311 SOUTHWEST BLVD, FORT WORTH, TX 76132-1063
(817) 738-3390
(817) 731-4282
Mailing address
6311 SOUTHWEST BLVD, FORT WORTH, TX 76132-1063
(817) 738-3390
(817) 731-4282
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
007141
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181326700
DEPARTMENT OF LABOR
—
01
—
7418670
AETNA
—
01
—
HH048A
BCBS
TX
Enumeration date
05/19/2006
Last updated
04/11/2024
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