MEDICARE: GLEN ECHO 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	:	1356704027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN ECHO SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	14201 DALLAS PKWY STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2916
Country	:	US
Telephone Number	:	972-763-3859
Fax Number	:	972-920-3445

Provider Business Practice Location Address
First Line	:	5550 FRIENDSHIP BLVD
Second Line	:	SUITE 100
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-7256
Country	:	US
Telephone Number	:	240-534-2972
Fax Number	:	240-534-2983

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	JONATHAN BAILEY
Credential	:
Telephone Number	:	203-609-1168

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	01/22/2026

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