Provider Demographics
NPI:1013264118
Name:TSC SURGICAL GROUP PLLC
Entity type:Organization
Organization Name:TSC SURGICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DHIRESH
Authorized Official - Middle Name:ROHAN
Authorized Official - Last Name:JEYARAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-619-3500
Mailing Address - Street 1:PO BOX 674096
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4096
Mailing Address - Country:US
Mailing Address - Phone:972-619-3500
Mailing Address - Fax:214-272-8985
Practice Address - Street 1:2805 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3561
Practice Address - Country:US
Practice Address - Phone:972-619-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK32632086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310761701Medicaid
TX310761701Medicaid