MEDICARE: DALLAS SURGI CENTER, INC.

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	000188	TX

General Provider Information

NPI Number	:	1548374267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS SURGI CENTER, INC.

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN STE 808
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-696-8828
Fax Number	:	214-696-1444

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN STE 808
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-696-8828
Fax Number	:	214-696-1444

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIS I COTTEL
Credential	:	M.D.
Telephone Number	:	214-696-8828

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/22/2020

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