MEDICARE: PARKHILL PEDIATRIC SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1063920627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKHILL PEDIATRIC SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	7150 GREENVILLE AVE STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5186
Country	:	US
Telephone Number	:	728-509-7675
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 GREENVILLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-7900
Country	:	US
Telephone Number	:	972-850-7675
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRENT MILLS
Credential	:
Telephone Number	:	601-297-0931

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	05/13/2020

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