Provider Demographics
NPI:1538354626
Name:PLEXCARE SURGICAL CENTER, INC.
Entity type:Organization
Organization Name:PLEXCARE SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADIMISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-834-8214
Mailing Address - Street 1:6333 AIRPORT FWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76117-5323
Mailing Address - Country:US
Mailing Address - Phone:817-834-8214
Mailing Address - Fax:817-834-8900
Practice Address - Street 1:3345 WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5604
Practice Address - Country:US
Practice Address - Phone:817-834-8214
Practice Address - Fax:817-834-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6734261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13808Medicare UPIN