MEDICARE: AUSTIN SFSC, 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	:	1437733896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN SFSC, LLC

Provider Business Mailing Address
First Line	:	1545 PINE ST APT 109
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 PINE ST APT 109
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4682
Country	:	US
Telephone Number	:	415-371-9928
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN, GOVERNING BODY
Name	:	DR. CHARLES LEE
Credential	:	MD
Telephone Number	:	415-933-8330

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/25/2021

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