MEDICARE: HUEBNER AMBULATORY SURGERY CENTER, 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	130329	TX

General Provider Information

NPI Number	:	1952852345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUEBNER AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	9618 HUEBNER RD STE 111
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1775
Country	:	US
Telephone Number	:	210-943-0999
Fax Number	:	210-943-0990

Provider Business Practice Location Address
First Line	:	9618 HUEBNER RD
Second Line	:	SUITE 111
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1660
Country	:	US
Telephone Number	:	405-697-2420
Fax Number	:

Authorized Official
Title or Position	:	VP-MANAGED CARE CONTRACTING
Name	:	TRISHA GRUS
Credential	:
Telephone Number	:	405-697-2420

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	01/19/2018

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