Provider Demographics
NPI:1568408201
Name:MEDICAL VILLAGE SURGERY CENTER INC.
Entity Type:Organization
Organization Name:MEDICAL VILLAGE SURGERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEBUM
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-647-8520
Mailing Address - Street 1:2507 MEDICAL ROW STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1070
Mailing Address - Country:US
Mailing Address - Phone:580-695-8749
Mailing Address - Fax:
Practice Address - Street 1:2507 MEDICAL ROW STE 101
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1070
Practice Address - Country:US
Practice Address - Phone:917-463-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
45C0001128Medicare UPIN