Healthcare Provider Details

I. General information

NPI: 1023316197
Provider Name (Legal Business Name): NORTH DALLAS SURGICAL CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 08/28/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17980 DALLAS PARKWAY SUITE 100
DALLAS TX
75287
US

IV. Provider business mailing address

17980 DALLAS PKWY STE 100
DALLAS TX
75287-6817
US

V. Phone/Fax

Practice location:
  • Phone: 817-556-8387
  • Fax:
Mailing address:
  • Phone: 972-913-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LESLEY WIGLE
Title or Position: CAO
Credential: RN
Phone: 972-913-7715