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General NPI Number Information
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NPI Number | 1871529388
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Entity Type | Organization
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Legal Business Name | PRG DALLAS ASC, LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 11442 N. CENTRAL EXPRESSWAY
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City | DALLAS
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State | TX
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Zip | 75243
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Country | US
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Telephone | 214-754-0000
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Fax | 214-379-1849
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Provider Business Mailing Address
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Address Line | 11442 N. CENTRAL EXPRESSWAY
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City | DALLAS
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State | TX
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Zip | 75243
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Country | US
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Telephone | 214-754-0000
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Fax | 214-379-1849
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Authorized Official
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Title or Position | OFFICER 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 | 007966
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License Number State | TX
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