REDBIRD SQUARE ENDOSCOPY CENTER LLC NPI 1114996774

NPI Information

  • NPI: 1114996774
  • Provider Name: REDBIRD SQUARE ENDOSCOPY CENTER LLC
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • :
  • CLIA Number: 45D0927207
  • Address: 3107 W CAMP WISDOM RD STE 189
    DALLAS, TX
    ZIP 75237
  • Phone: (214) 331-2922

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NPI Details

REDBIRD SQUARE ENDOSCOPY CENTER LLC is an ambulatory surgical clinic center in Dallas, TX. REDBIRD SQUARE ENDOSCOPY CENTER LLC NPI is 1114996774. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

3107 W CAMP WISDOM RD STE 189
DALLAS, TX
ZIP 75237-638
Phone: (214) 331-2922
Fax: (214) 331-0413

The provider's authorized official is Jennifer Boyd Baldock .
The authorized official title is Vp And Authorized Official and has the following contact phone number (615) 234-5954.

The CLIA number assigned to this NPI record is 45D0927207 - physician office with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Biopsy of large bowel using a flexible endoscope (HCPCS:45380)
  • Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS:43239)
  • Removal of polyps or growths of large bowel using an endoscope with mechanical snare (HCPCS:45385)
  • Colorectal cancer screening; colonoscopy on individual at high risk (HCPCS:G0105)
  • Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (HCPCS:G0121)
  • Diagnostic exam of large bowel using a flexible endoscope (HCPCS:45378)
  • Injection beneath lining of large bowel using a flexible endoscope (HCPCS:45381)
  • Dilation of esophagus (HCPCS:43450)
  • Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm (HCPCS:43249)

The enumeration date for this NPI number is 3/16/2006 and was last updated on 10/30/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory Surgical007032TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1087966001MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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