Provider Demographics
NPI:1821182965
Name:MERIDIAN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MERIDIAN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:TJELMELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-617-7505
Mailing Address - Street 1:4220 BULL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6026
Mailing Address - Country:US
Mailing Address - Phone:512-617-7500
Mailing Address - Fax:512-323-9382
Practice Address - Street 1:4220 BULL CREEK RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6026
Practice Address - Country:US
Practice Address - Phone:512-617-7500
Practice Address - Fax:512-323-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008080261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC251Medicare ID - Type Unspecified