Provider Demographics
NPI:1306830500
Name:FOUNDATION SURGERY AFFILIATES OF SEGUIN, LLC
Entity Type:Organization
Organization Name:FOUNDATION SURGERY AFFILIATES OF SEGUIN, LLC
Other - Org Name:SOUTH TEXAS SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-401-2800
Mailing Address - Street 1:214 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-401-2800
Mailing Address - Fax:730-401-4346
Practice Address - Street 1:214 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-401-2800
Practice Address - Fax:830-401-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008149261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171181401Medicaid
ASC236Medicare UPIN
TX171181401Medicaid