MEDICARE: SOUTH AUSTIN SURGERY CENTER LTD

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	007954	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386609964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH AUSTIN SURGERY CENTER LTD

Provider Business Mailing Address
First Line	:	4307 JAMES CASEY ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3365
Country	:	US
Telephone Number	:	512-416-6006
Fax Number	:	512-416-0881

Provider Business Practice Location Address
First Line	:	4307 JAMES CASEY ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3365
Country	:	US
Telephone Number	:	512-416-6006
Fax Number	:	512-416-0881

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM GREGORY SWINNEY
Credential	:
Telephone Number	:	972-789-2877

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	04/23/2018

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