Provider Demographics
NPI:1235257130
Name:SWISS AVENUE SURGICENTER MANAGEMENT LLC
Entity Type:Organization
Organization Name:SWISS AVENUE SURGICENTER MANAGEMENT LLC
Other - Org Name:SWISS AVENUE SURGICENTER LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-821-2001
Mailing Address - Street 1:4103 SWISS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8102
Mailing Address - Country:US
Mailing Address - Phone:214-821-2001
Mailing Address - Fax:214-821-2047
Practice Address - Street 1:4103 SWISS AVE STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8102
Practice Address - Country:US
Practice Address - Phone:214-821-2001
Practice Address - Fax:214-821-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008097261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC226Medicare ID - Type Unspecified