Provider Demographics
NPI:1891788584
Name:ROCKWALL AMBULATORY SURGERY CENTER LLP
Entity Type:Organization
Organization Name:ROCKWALL AMBULATORY SURGERY CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-772-6166
Mailing Address - Street 1:14201 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2916
Mailing Address - Country:US
Mailing Address - Phone:972-772-6166
Mailing Address - Fax:972-772-6167
Practice Address - Street 1:6435 S FM 549
Practice Address - Street 2:STE 101
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6221
Practice Address - Country:US
Practice Address - Phone:972-722-9003
Practice Address - Fax:972-722-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008119261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710188Medicaid
TXASC232Medicare PIN
TX45C0001373Medicare Oscar/Certification