Provider Demographics
NPI:1568979805
Name:ST DAVIDS AUSTIN AREA ASC LLC
Entity Type:Organization
Organization Name:ST DAVIDS AUSTIN AREA ASC LLC
Other - Org Name:ST . DAVID'S AUSTIN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2897
Mailing Address - Street 1:12200 RENFERT WAY STE G-2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5653
Mailing Address - Country:US
Mailing Address - Phone:512-901-8340
Mailing Address - Fax:512-901-8339
Practice Address - Street 1:12200 RENFERT WAY STE G-2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5653
Practice Address - Country:US
Practice Address - Phone:512-901-8340
Practice Address - Fax:512-901-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical