Provider Demographics
NPI:1649494170
Name:SOUTHWEST ENDOSCOPY AND SURGERY CENTER
Entity type:Organization
Organization Name:SOUTHWEST ENDOSCOPY AND SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUKHTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-293-9292
Mailing Address - Street 1:701 E RENDON CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7536
Mailing Address - Country:US
Mailing Address - Phone:817-293-9292
Mailing Address - Fax:
Practice Address - Street 1:701 E RENDON CROWLEY RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7536
Practice Address - Country:US
Practice Address - Phone:817-293-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008364261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX490002791OtherMEDICARE RR
TX085950601Medicaid
TXHH1373OtherBCBS
TX451184Medicare PIN