Provider Demographics
NPI:1952852345
Name:HUEBNER AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HUEBNER AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-697-2420
Mailing Address - Street 1:9618 HUEBNER RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1775
Mailing Address - Country:US
Mailing Address - Phone:210-943-0999
Mailing Address - Fax:210-943-0990
Practice Address - Street 1:9618 HUEBNER RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1660
Practice Address - Country:US
Practice Address - Phone:405-697-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130329261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical