Provider Demographics
NPI:1902218456
Name:TEXAS ENDOSCOPY CENTERS, LLC
Entity Type:Organization
Organization Name:TEXAS ENDOSCOPY CENTERS, LLC
Other - Org Name:TEXAS ENDOSCOPY AT INDEPENDENCE MEDICAL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:8080 INDEPENDENCE PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4000
Mailing Address - Country:US
Mailing Address - Phone:972-908-3000
Mailing Address - Fax:972-908-3030
Practice Address - Street 1:8080 INDEPENDENCE PKWY
Practice Address - Street 2:STE 160
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4000
Practice Address - Country:US
Practice Address - Phone:972-908-3000
Practice Address - Fax:972-908-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130197261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
533967Medicare UPIN
TX45C0001391Medicare Oscar/Certification