Provider Demographics
NPI:1083176309
Name:SPICEWOOD SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SPICEWOOD SURGERY CENTER LLC
Other - Org Name:SPICEWOOD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARKET PRESIDENT / AUTHORIZED OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:13617 CALDWELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2324
Mailing Address - Country:US
Mailing Address - Phone:512-637-5563
Mailing Address - Fax:
Practice Address - Street 1:13617 CALDWELL DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2324
Practice Address - Country:US
Practice Address - Phone:512-637-5563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083176309OtherNPI