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NPI Code Detail

MEDICARE: HYDE PARK SURGERY CENTER, LLC

MEDICARE: HYDE PARK 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
1261QA1903XAmbulatory Surgical Clinic/Center
2261QA1903XAmbulatory Surgical Clinic/Center008677TX

General Provider Information

NPI Number : 1962671487
Entity Type Code : Organization
Provider Name (Legal Business Name) : HYDE PARK SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 4611 GUADALUPE STREET
Second Line : SUITE 100
City : AUSTIN
State : TX
Zip : 78751-2928
Country : US
Telephone Number : 512-420-2303
Fax Number : 512-420-2379
Provider Business Practice Location Address
First Line : 4611 GUADALUPE ST., SUITE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78751-2908
Country : US
Telephone Number : 512-420-2303
Fax Number : 512-420-2379
Authorized Official
Title or Position : OFFICER/AUTHORIZED OFFICIAL
Name : PETER BLACH
Credential :
Telephone Number : 713-343-0832
Provider Enumeration Date : 02/28/2008
Last Update Date : 10/09/2024

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Directions to “HYDE PARK SURGERY CENTER, LLC ” Practice Location

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