Provider Demographics
NPI:1801854591
Name:SAN ANTONIO SURGERY CENTER
Entity Type:Organization
Organization Name:SAN ANTONIO SURGERY CENTER
Other - Org Name:THE CENTER FOR SPECIAL SURGERY @ TCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RANDELL
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-0187
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:SUBLEVEL 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-614-0187
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUBLEVEL 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-614-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000171261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ04510682Medicaid
TX451068Medicare PIN