MEDICARE: SURGCENTER OF WESTOVER HILLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1205267341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGCENTER OF WESTOVER HILLS LLC

Provider Business Mailing Address
First Line	:	1927 ROGERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1927 ROGERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4614
Country	:	US
Telephone Number	:	830-446-6441
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SCOTT WORRICH
Credential	:	MD
Telephone Number	:	830-446-6441

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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