Healthcare Provider Details

I. General information

NPI: 1811286875
Provider Name (Legal Business Name): WHOLE WOMAN'S SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 E SOUTHCROSS BLVD
SAN ANTONIO TX
78222-3641
US

IV. Provider business mailing address

8401 N I H 35 SUITE 1A
AUSTIN TX
78753-5751
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-4251
  • Fax: 888-724-3239
Mailing address:
  • Phone: 512-835-6858
  • Fax: 888-724-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number26045
License Number StateTX

VIII. Authorized Official

Name: MRS. VIRGINIA E SMITH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 888-737-9615