MEDICARE: ELLIS COUNTY SURGERY AND ENDOSCOPY CENTER PLLC

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1598594244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIS COUNTY SURGERY AND ENDOSCOPY CENTER PLLC

Provider Business Mailing Address
First Line	:	269 E OVILLA RD STE 200
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-2616
Country	:	US
Telephone Number	:	469-719-3690
Fax Number	:	469-719-3680

Provider Business Practice Location Address
First Line	:	269 E OVILLA RD STE 200
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-2616
Country	:	US
Telephone Number	:	469-719-3690
Fax Number	:	469-719-3680

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	FEDERICO MAESE
Credential	:	MD
Telephone Number	:	469-694-5408

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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