Provider Demographics
NPI:1891947057
Name:SURGICAL ASSISTANCE OF GREATER DALLAS, LLC.
Entity Type:Organization
Organization Name:SURGICAL ASSISTANCE OF GREATER DALLAS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:214-507-9306
Mailing Address - Street 1:3021 RIDGE RD
Mailing Address - Street 2:SUITE A 231
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5806
Mailing Address - Country:US
Mailing Address - Phone:214-507-9306
Mailing Address - Fax:469-338-5928
Practice Address - Street 1:3021 RIDGE RD
Practice Address - Street 2:SUITE A 231
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5806
Practice Address - Country:US
Practice Address - Phone:214-507-9306
Practice Address - Fax:469-338-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00036246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty