Healthcare Provider Details

I. General information

NPI: 1639093719
Provider Name (Legal Business Name): BSA CARDIAC ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W I 40
AMARILLO TX
79106-2512
US

IV. Provider business mailing address

340 SEVEN SPRINGS WAY STE 100
BRENTWOOD TN
37027-5697
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-9464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C. PETROVICH
Title or Position: EVP, GENERAL COUNSEL
Credential:
Phone: 615-296-3594