Provider Demographics
NPI:1396762027
Name:TEXAS GI ENDOSCOPY CENTER
Entity type:Organization
Organization Name:TEXAS GI ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:G
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-270-3590
Mailing Address - Street 1:2704 N GALLOWAY
Mailing Address - Street 2:STE 102
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-270-3590
Mailing Address - Fax:972-270-3572
Practice Address - Street 1:2704 N GALLOWAY
Practice Address - Street 2:STE 102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-270-3590
Practice Address - Fax:972-270-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007938261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH000AOtherBCBS
TXHH000AOtherBCBS