Provider Demographics
NPI:1518943679
Name:DALLAS ENDOSCOPY CENTER, LTD
Entity Type:Organization
Organization Name:DALLAS ENDOSCOPY CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-RUESGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-1730
Mailing Address - Street 1:PO BOX 679006
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-9006
Mailing Address - Country:US
Mailing Address - Phone:214-520-8235
Mailing Address - Fax:214-520-8236
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:214-520-8235
Practice Address - Fax:214-520-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
TX008262261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1761223Medicaid
TXASC263Medicare PIN
TXASC263Medicare ID - Type Unspecified