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General NPI Number Information
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NPI Number | 1962459610
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS DAY SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 3800 S W S YOUNG DR STE 204
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City | KILLEEN
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State | TX
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Zip | 76542-3340
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Country | US
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Telephone | 254-245-9175
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Fax | 254-213-7771
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Provider Business Mailing Address
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Address Line | PO BOX 11538
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City | KILLEEN
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State | TX
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Zip | 76547-1538
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Country | US
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Telephone | 254-245-9177
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Fax | 254-245-9178
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT A IRVINE
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Credential |
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Telephone | 254-245-9175
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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 | 130129
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License Number State | TX
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