Provider Demographics
NPI:1508025693
Name:SOUTHCROSS SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHCROSS SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-255-8084
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2118
Mailing Address - Country:US
Mailing Address - Phone:210-530-4075
Mailing Address - Fax:210-530-4081
Practice Address - Street 1:4025 E. SOUTHCROSS
Practice Address - Street 2:BLDG 3 STE. 15
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222
Practice Address - Country:US
Practice Address - Phone:210-530-4075
Practice Address - Fax:210-530-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008629261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008629OtherDEPT OF STATE HEALTH SERVICES FACILITY LICENSING GROUP