MEDICARE: SURGCENTER OF GREATER DALLAS, 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	:	1245798826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGCENTER OF GREATER DALLAS, LLC.

Provider Business Mailing Address
First Line	:	11411 E NORTHWEST HWY STE 220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-1437
Country	:	US
Telephone Number	:	469-214-4344
Fax Number	:

Provider Business Practice Location Address
First Line	:	11411 E NORTHWEST HWY STE 220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-1437
Country	:	US
Telephone Number	:	469-563-8932
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	DONITA FLEMING
Credential	:
Telephone Number	:	202-815-3665

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	01/26/2026

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