Provider Demographics
NPI:1033564414
Name:TEXAS CENTER FOR INTERVENTIONAL SURGERY, LLC
Entity Type:Organization
Organization Name:TEXAS CENTER FOR INTERVENTIONAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAK
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)(CT) MBA
Authorized Official - Phone:972-733-0014
Mailing Address - Street 1:4450 SOJOURN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5041
Mailing Address - Country:US
Mailing Address - Phone:469-801-5007
Mailing Address - Fax:972-733-0125
Practice Address - Street 1:4450 SOJOURN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5041
Practice Address - Country:US
Practice Address - Phone:972-733-0014
Practice Address - Fax:972-733-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical