Provider Demographics
NPI:1073822425
Name:MISI ASC DALLAS, LLC
Entity Type:Organization
Organization Name:MISI ASC DALLAS, LLC
Other - Org Name:MISI, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FOUNDER/BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BASSEM
Authorized Official - Last Name:RIMLAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-884-4301
Mailing Address - Street 1:10400 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:972-884-4370
Mailing Address - Fax:972-884-4321
Practice Address - Street 1:10400 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:972-884-4370
Practice Address - Fax:972-884-4321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISI, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-04
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
TX130080261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical