1245798826 NPI number — SURGCENTER OF GREATER DALLAS, LLC.

Table of content: (NPI 1245798826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245798826 NPI number — SURGCENTER OF GREATER DALLAS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
SURGCENTER OF GREATER DALLAS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1245798826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5229 RAGAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE COLONY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75056-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11411 E NORTHWEST HWY STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75218-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-563-8932
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCLELLAND
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE ADMINISTRATOR
Authorized Official Telephone Number:
469-563-8932

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)