Provider Demographics
NPI:1588629604
Name:GREENVILLE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GREENVILLE SURGERY CENTER, LLC
Other - Org Name:TEXAS HEALTH SURGERY CENTER DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ABLE
Authorized Official - Last Name:GAYTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-503-9778
Mailing Address - Street 1:7150 GREENVILLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5198
Mailing Address - Country:US
Mailing Address - Phone:214-891-0466
Mailing Address - Fax:214-891-1628
Practice Address - Street 1:7150 GREENVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5198
Practice Address - Country:US
Practice Address - Phone:214-891-0466
Practice Address - Fax:214-891-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-1063Medicare PIN