MEDICARE: PSA AMBULATORY SURGICAL CENTER OF AUSTIN 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	:	1417827494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSA AMBULATORY SURGICAL CENTER OF AUSTIN LLC

Provider Business Mailing Address
First Line	:	2218 SOUTH LAKELINE BLVD
Second Line	:	BUILDING 1, SUITE 101
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4755
Country	:	US
Telephone Number	:	512-953-8134
Fax Number	:	737-689-4102

Provider Business Practice Location Address
First Line	:	2218 SOUTH LAKELINE BLVD
Second Line	:	BUILDING 1, SUITE 101
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4755
Country	:	US
Telephone Number	:	512-953-8134
Fax Number	:	737-689-4102

Authorized Official
Title or Position	:	CFO
Name	:	JULIE MEYER
Credential	:
Telephone Number	:	512-485-7200

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	06/11/2026

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