MEDICARE: SURGICAL ASSISTANCE OF GREATER DALLAS, 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	246Z00000X	Other Specialist/Technologist	00036	TX

General Provider Information

NPI Number	:	1891947057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ASSISTANCE OF GREATER DALLAS, LLC.

Provider Business Mailing Address
First Line	:	3021 RIDGE RD
Second Line	:	SUITE A 231
City	:	ROCKWALL
State	:	TX
Zip	:	75032-5806
Country	:	US
Telephone Number	:	214-507-9306
Fax Number	:	469-338-5928

Provider Business Practice Location Address
First Line	:	3021 RIDGE RD
Second Line	:	SUITE A 231
City	:	ROCKWALL
State	:	TX
Zip	:	75032-5806
Country	:	US
Telephone Number	:	214-507-9306
Fax Number	:	469-338-5928

Authorized Official
Title or Position	:	OWNER
Name	:	CODY LYNN DAY
Credential	:	L.S.A.
Telephone Number	:	214-507-9306

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/13/2015

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