Provider Demographics
NPI:1891674255
Name:BAYLOR SCOTT & WHITE SURGICARE AT WEATHERFORD LLC
Entity type:Organization
Organization Name:BAYLOR SCOTT & WHITE SURGICARE AT WEATHERFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AO
Authorized Official - Prefix:
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-815-3665
Mailing Address - Street 1:1719 MARIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1719 MARIN DRIVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:469-872-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical