Provider Demographics
NPI:1346248440
Name:DALLAS SURGICAL PARTNERS, LLC
Entity Type:Organization
Organization Name:DALLAS SURGICAL PARTNERS, LLC
Other - Org Name:PHYSICIANS DAYSURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:3930 CRUTCHER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1701
Mailing Address - Country:US
Mailing Address - Phone:214-827-0760
Mailing Address - Fax:214-827-0944
Practice Address - Street 1:3930 CRUTCHER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1701
Practice Address - Country:US
Practice Address - Phone:214-827-0760
Practice Address - Fax:214-827-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007821261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085877102Medicaid
TX085877102Medicaid