Provider Demographics
NPI:1598594244
Name:ELLIS COUNTY SURGERY AND ENDOSCOPY CENTER PLLC
Entity type:Organization
Organization Name:ELLIS COUNTY SURGERY AND ENDOSCOPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-694-5408
Mailing Address - Street 1:269 E OVILLA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2616
Mailing Address - Country:US
Mailing Address - Phone:469-719-3690
Mailing Address - Fax:469-719-3680
Practice Address - Street 1:269 E OVILLA RD STE 200
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2616
Practice Address - Country:US
Practice Address - Phone:469-719-3690
Practice Address - Fax:469-719-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty