Medical City Surgery Center Southlake, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MEDICAL CITY SURGERY CENTER SOUTHLAKE, LLC

Doing business as

Medical City Surgery Center Southlake

Practice address

2815 W Southlake Blvd Ste 100
Southlake, TX 76092-1498

Phone

(817) 431-3200

Fax

(817) 431-3117

NPI assigned

Mar 25, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David McKnight

Title

VP/Cfo

Phone

(972) 789-2816

Specialties & licenses 1

Addresses

Other names 1

• Medical City Surgery Center Southlake Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Medical City Surgery Center Southlake LLC Dba Medical City Surgery CenterCCN 45C0001596

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1144970807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2815 W SOUTHLAKE BLVD STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921498",
            "telephone_number": "817-431-3200",
            "fax_number": "817-431-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 W SOUTHLAKE BLVD STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921498",
            "telephone_number": "817-431-3200",
            "fax_number": "817-431-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CITY SURGERY CENTER SOUTHLAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-25",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "972-789-2816"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical City Surgery Center Southlake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen D McNiel, APRN-CNP
• Dylan James McNutt, PHARMD, RPH
• Thomas McSpadden, LPC
• Med Southwest, PLLC
• Medical Air Services Association
• Mediclink Management Group
• Mediclinkmd One-P LLC
• Medico PS, LLC
• Omar Medina Muniz
• Medx Imaging LLC

• Ambulatory Surgical Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.