MEDICARE: GREENVILLE 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	:	1588629604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	7150 GREENVILLE AVE STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5198
Country	:	US
Telephone Number	:	214-891-0466
Fax Number	:	214-891-1628

Provider Business Practice Location Address
First Line	:	7150 GREENVILLE AVE STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5198
Country	:	US
Telephone Number	:	214-891-0466
Fax Number	:	214-891-1628

Authorized Official
Title or Position	:	CEO
Name	:	ANTOINE CROWDER
Credential	:
Telephone Number	:	214-891-0466

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	02/25/2026

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