MEDICARE: ENCORE ASC, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130516	OTHER	TX	ASC LICENSE

General Provider Information

NPI Number	:	1831714419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE ASC, LLC

Provider Business Mailing Address
First Line	:	2200 PHYSICIANS BLVD STE 200
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-6247
Country	:	US
Telephone Number	:	972-945-5800
Fax Number	:	972-846-6882

Provider Business Practice Location Address
First Line	:	2200 PHYSICIANS BLVD STE A
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-6248
Country	:	US
Telephone Number	:	972-945-5800
Fax Number	:	972-846-6882

Authorized Official
Title or Position	:	ADMIN
Name	:	GARY MARTIN
Credential	:
Telephone Number	:	469-215-3494

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	11/30/2021

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Directions to “ENCORE ASC, LLC ” Practice Location

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