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General NPI Number Information
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NPI Number | 1114996774
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Entity Type | Organization
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Legal Business Name | REDBIRD SQUARE ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 3107 W CAMP WISDOM RD STE 189
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City | DALLAS
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State | TX
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Zip | 75237-2638
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Country | US
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Telephone | 214-331-2922
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Fax | 214-331-0413
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Provider Business Mailing Address
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Address Line | 3107 W CAMP WISDOM RD STE 189
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City | DALLAS
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State | TX
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Zip | 75237-2638
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Country | US
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Telephone | 214-331-2922
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Fax | 214-331-0413
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Authorized Official
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Title or Position | VP AND AUTHORIZED OFFICIAL
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Name | JENNIFER BOYD BALDOCK
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Credential |
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Telephone | 615-234-5954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007032
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License Number State | TX
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