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General NPI Number Information
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NPI Number | 1295716264
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Entity Type | Organization
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Legal Business Name | SAN ANGELO AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3605 EXECUTIVE DR
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City | SAN ANGELO
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State | TX
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Zip | 76904-6884
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Country | US
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Telephone | 325-223-0555
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Fax | 325-223-0909
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Provider Business Mailing Address
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Address Line | 3605 EXECUTIVE DR
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City | SAN ANGELO
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State | TX
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Zip | 76904-6884
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Country | US
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Telephone | 325-223-0555
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Fax | 325-223-0909
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SEAN ALLEN GUETLEIN
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Credential |
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Telephone | 325-223-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008075
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License Number State | TX
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