Provider Demographics
NPI:1295702942
Name:GRAPEVINE SURGICARE PARTNERS LTD
Entity type:Organization
Organization Name:GRAPEVINE SURGICARE PARTNERS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
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 1:905 E SOUTHLAKE BLVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8602
Mailing Address - Country:US
Mailing Address - Phone:817-410-4300
Mailing Address - Fax:817-410-4303
Practice Address - Street 1:905 E SOUTHLAKE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8602
Practice Address - Country:US
Practice Address - Phone:817-410-4300
Practice Address - Fax:817-410-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007819261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173382601Medicaid
TX490005386OtherRAILROAD MEDICARE
TX490005386OtherRAILROAD MEDICARE
TX173382601Medicaid