MEDICARE: CREEKSIDE SURGICAL

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	207X00000X	Orthopaedic Surgery Physician	H6973	TX

General Provider Information

NPI Number	:	1255600508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREEKSIDE SURGICAL

Provider Business Mailing Address
First Line	:	8900 SHOAL CREEK BLVD
Second Line	:	BLDG 301B
City	:	AUSTIN
State	:	TX
Zip	:	78757-6810
Country	:	US
Telephone Number	:	512-407-6855
Fax Number	:	512-524-2251

Provider Business Practice Location Address
First Line	:	8900 SHOAL CREEK BLVD
Second Line	:	BLDG 301B
City	:	AUSTIN
State	:	TX
Zip	:	78757-6810
Country	:	US
Telephone Number	:	512-407-6855
Fax Number	:	512-524-2251

Authorized Official
Title or Position	:	MSO MANAGER
Name	:	MRS. CANDICE AGUIRRE
Credential	:
Telephone Number	:	512-407-6855

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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Directions to “CREEKSIDE SURGICAL ” Practice Location

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