Provider Demographics
NPI:1669711594
Name:IHEART AMB-SURG DMC LLC
Entity type:Organization
Organization Name:IHEART AMB-SURG DMC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-244-9820
Mailing Address - Street 1:9 MEDICAL PKWY
Mailing Address - Street 2:STE 308
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7858
Mailing Address - Country:US
Mailing Address - Phone:214-244-9820
Mailing Address - Fax:
Practice Address - Street 1:9 MEDICAL PKWY
Practice Address - Street 2:STE 308
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7858
Practice Address - Country:US
Practice Address - Phone:214-244-9820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical