Medical Village Surgery Center Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MEDICAL VILLAGE SURGERY CENTER INC.

Practice address

2507 Medical Row Ste 101
Grand Prairie, TX 75051-1070

Phone

(917) 463-8580

NPI assigned

Jun 21, 2006

Last updated

Feb 26, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gebum Yu

Title

Administrator

Phone

(214) 931-6133

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568408201. Details of each certification follow.

• CCN 45C0451274 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 45C0451274

Legal name

MEDICAL VILLAGE SURGERY CENTER INC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Dec 30, 2023

Last certification

Dec 30, 2023

Ownership / control type

Proprietary

Facility address

2507 Medical Row Ste 101
Grand Prairie, TX 75051

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1568408201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 MEDICAL ROW STE 101",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511070",
            "telephone_number": "972-647-8520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 MEDICAL ROW STE 101",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511070",
            "telephone_number": "917-463-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL VILLAGE SURGERY CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "YU",
        "authorized_official_first_name": "GEBUM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "214-931-6133"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.