Healthcare Provider Details

I. General information

NPI: 1518943679
Provider Name (Legal Business Name): DALLAS ENDOSCOPY CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 CRUTCHER ST
DALLAS TX
75246-1701
US

IV. Provider business mailing address

PO BOX 679006
DALLAS TX
75267-9006
US

V. Phone/Fax

Practice location:
  • Phone: 214-520-8235
  • Fax: 214-520-8236
Mailing address:
  • Phone: 214-520-8235
  • Fax: 214-520-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number008262
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO RODRIGUEZ-RUESGA
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 214-824-1730