Provider Demographics
NPI:1679832059
Name:MEDCENTER SURGERY CENTER INC
Entity Type:Organization
Organization Name:MEDCENTER SURGERY CENTER INC
Other - Org Name:MEDPLAZA TOXICOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:210-598-2852
Mailing Address - Street 1:2425 BABCOCK RD.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4899
Mailing Address - Country:US
Mailing Address - Phone:210-598-2852
Mailing Address - Fax:210-598-2853
Practice Address - Street 1:2425 BABCOCK RD.
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-598-2852
Practice Address - Fax:210-598-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2024554291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2024554OtherCLIA