Provider Demographics
NPI:1225375587
Name:GCSA AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GCSA AMBULATORY SURGERY CENTER, LLC
Other - Org Name:GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO - STONE OAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:4801 NW LOOP 410 STE 812
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5347
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:210-614-0952
Practice Address - Street 1:855 PROTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4203
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-614-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical