Advanced Gastroenterology of Texas PLLC
Organization Active NPI Gastroenterology Physician · Mesquite, TX
NPI 1942685409 · NPPES record last updated Nov 5, 2015
Key facts
- NPI
- 1942685409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- N9262 (TX)
- Legal business name
- ADVANCED GASTROENTEROLOGY OF TEXAS PLLC
- Practice address
- 2698 North Galloway
Suite 103
Mesquite, TX 75150 - Phone
- (214) 962-4863
- Fax
- (214) 758-1400
- NPI assigned
- Jul 27, 2015
- Organization subpart
- No
Authorized official
- Name
- Farbod Masrour, DO
- Title
- Owner
- Phone
- (214) 320-7680
Practitioners 3
-
Farbod Masrour, D.O,
-
Massoud Rasooli, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151005000805 | TX | Part B Supplier - Clinic/Group Practice | 4284942640 |
Receives reassigned benefits from 3 practitioners Practice locations: Dallas, TX; Mesquite, TX |
National Provider Directory
Locations
9 Medical Pkwy
Ste 2064
Dallas, TX 75234
9 Medical Pkwy
Ste 4
Dallas, TX 75234
2698 N Galloway Ave
Ste 206
Mesquite, TX 75150
Phone (214) 962-4863
2540 N Galloway Ave
Ste 205
Mesquite, TX 75150
Phone (214) 962-4862
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician |
207RG0100X | N9262 | TX | Yes |
Addresses
Primary practice location
2698 North Galloway
Suite 103
Mesquite, TX 75150
Mailing address
PO Box 801344
Dallas, TX 75380-1344
Phone (214) 962-4863
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All providers in Mesquite, TX · Gastroenterology Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.