Provider Demographics
NPI:1073999801
Name:CENTRAL DALLAS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL DALLAS SURGERY CENTER, LLC
Other - Org Name:CENTRAL DALLAS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-355-8614
Mailing Address - Street 1:5920 FOREST PARK RD
Mailing Address - Street 2:STE, 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6411
Mailing Address - Country:US
Mailing Address - Phone:214-350-2400
Mailing Address - Fax:
Practice Address - Street 1:5920 FOREST PARK RD
Practice Address - Street 2:STE, 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6411
Practice Address - Country:US
Practice Address - Phone:214-350-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130245261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical