Waco Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WACO ENDOSCOPY CENTER, LLC

Practice address

2510 Ambassador Drive
Suite a
Waco, TX 76712

Phone

(817) 893-2381

NPI assigned

May 24, 2024

Last updated

May 24, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

GI ALLIANCE SURGERY CENTER, PLLCAs reported in NPPES

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

Authorized official

Name

Kelly Rouvaldt

Title

Director of Ascs

Phone

(817) 893-2381

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912746264. Details of each certification follow.

• CCN 45C0451321 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 45C0451321

Legal name

Waco Endoscopy Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Sep 18, 2025

Last certification

Aug 27, 2025

Facility address

2510 Ambassador Drive Suite A
Waco, TX 76712

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Flower Mound, TX
  • NPI 1689650475

  Member Of

  NPD member

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

{
    "created_epoch": "1716508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1912746264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 RESERVE ST STE 550",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921604",
            "telephone_number": "817-893-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 AMBASSADOR DRIVE",
            "address_2": "SUITE A",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76712",
            "telephone_number": "817-893-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GI ALLIANCE SURGERY CENTER, PLLC",
        "enumeration_date": "2024-05-24",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "ROUVALDT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR OF ASCS",
        "authorized_official_telephone_number": "817-893-2381"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2510 Ambassador Drive",
            "address_2": "Suite A",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "76712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Waco Bone & Joint Clinic, P.a.
• Waco Cardiology Associates
• Waco Center for Oral & Maxillofacial Surgery PLLC
• Waco Center for Women's Health, P.a.
• Waco Dental and Orthodontics, PLLC (Rodeo Dental and Orthodontics)
• Waco Eye Associates, PA
• Waco Eye Surgery Center LLC
• Waco Functional Medicine, PA
• Waco Gastroenterology Associates
• Waco Gastroenterology Endoscopy Center LLC (Waco Gastroenterology Endoscopy Center)

• Ambulatory Surgical Clinic/Center in Waco, TX
• Providers in Waco, 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 May 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.