Provider Demographics
NPI:1558517821
Name:BABCOCK SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:BABCOCK SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-255-8084
Mailing Address - Street 1:MSC 150
Mailing Address - Street 2:P.O. BOX 2458
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2458
Mailing Address - Country:US
Mailing Address - Phone:210-255-8084
Mailing Address - Fax:
Practice Address - Street 1:2425 BABCOCK RD
Practice Address - Street 2:SUITE #106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4895
Practice Address - Country:US
Practice Address - Phone:210-255-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008675261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical