Provider Demographics
NPI:1407144132
Name:STONE OAK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:STONE OAK SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEC
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-267-1374
Mailing Address - Street 1:123 N LOOP 1604 E
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1388
Mailing Address - Country:US
Mailing Address - Phone:210-267-1374
Mailing Address - Fax:210-267-1459
Practice Address - Street 1:123 N LOOP 1604 E
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1388
Practice Address - Country:US
Practice Address - Phone:210-267-1374
Practice Address - Fax:210-267-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical