Basic Information
| Provider Information | |||||||||
| NPI: | 1033564414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS CENTER FOR INTERVENTIONAL SURGERY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4450 SOJOURN DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750015041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4698015007 | ||||||||
| FaxNumber: | 9727330125 | ||||||||
| Practice Location | |||||||||
| Address1: | 4450 SOJOURN DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750015041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727330014 | ||||||||
| FaxNumber: | 9727330125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2016 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | BARAK | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, CLINICAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9727330014 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RT (R)(CT) MBA | ||||||||
| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.