Provider Demographics
NPI:1669845632
Name:LIBERTY HILL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LIBERTY HILL SURGERY CENTER LLC
Other - Org Name:LIBERTY HILL SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:512-656-2928
Mailing Address - Street 1:171 ROCK HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6305
Mailing Address - Country:US
Mailing Address - Phone:512-656-2928
Mailing Address - Fax:512-343-2598
Practice Address - Street 1:171 ROCK HOUSE DR
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6305
Practice Address - Country:US
Practice Address - Phone:512-656-2928
Practice Address - Fax:512-343-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty