Provider Demographics
NPI:1922301712
Name:THE SURGERY CENTER AT WILLIAMSON LLC
Entity Type:Organization
Organization Name:THE SURGERY CENTER AT WILLIAMSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:301 SETON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-8032
Mailing Address - Country:US
Mailing Address - Phone:512-861-4214
Mailing Address - Fax:512-861-4201
Practice Address - Street 1:301 SETON PKWY
Practice Address - Street 2:STE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8002
Practice Address - Country:US
Practice Address - Phone:512-861-4214
Practice Address - Fax:512-861-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130083261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2885824Medicaid
TXP01017562OtherRAILROAD MEDICARE
TX2885824Medicaid
TXASC441Medicare PIN