Provider Demographics
NPI:1013468586
Name:LAKEWAY AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LAKEWAY AMBULATORY SURGERY CENTER, LLC
Other - Org Name:LAKEWAY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:5329 SERENE HILLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1257
Mailing Address - Country:US
Mailing Address - Phone:512-357-8220
Mailing Address - Fax:
Practice Address - Street 1:5329 SERENE HILLS DR STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-1257
Practice Address - Country:US
Practice Address - Phone:512-357-8220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical