Provider Demographics
NPI:1831714419
Name:ENCORE ASC, LLC
Entity type:Organization
Organization Name:ENCORE ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-215-3494
Mailing Address - Street 1:2200 PHYSICIANS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-6247
Mailing Address - Country:US
Mailing Address - Phone:972-945-5800
Mailing Address - Fax:972-846-6882
Practice Address - Street 1:2200 PHYSICIANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6248
Practice Address - Country:US
Practice Address - Phone:972-945-5800
Practice Address - Fax:972-846-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130516OtherASC LICENSE