Provider Demographics
NPI:1962459610
Name:CENTRAL TEXAS DAY SURGERY CENTER LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:CENTRAL TEXAS DAY SURGERY CENTER LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-245-9175
Mailing Address - Street 1:PO BOX 11538
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1538
Mailing Address - Country:US
Mailing Address - Phone:254-245-9177
Mailing Address - Fax:254-245-9178
Practice Address - Street 1:3800 S W S YOUNG DR STE 204
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3340
Practice Address - Country:US
Practice Address - Phone:254-245-9175
Practice Address - Fax:254-213-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130129261QA1903X
261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX490000381OtherCARE
TXHH1256OtherBLUE CROSS BLUE SHIELD
TX49004797OtherPALMETTO GBA
TX085869801Medicaid
TX085869801Medicaid
TX102774100OtherFIRST CARE
TX085869801Medicaid
TX102774100OtherFIRST CARE
TXHH1256OtherBLUE CROSS BLUE SHIELD