Provider Demographics
NPI:1497173801
Name:EHI SURGERY CENTER AUSTIN, LLC
Entity type:Organization
Organization Name:EHI SURGERY CENTER AUSTIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-6285
Mailing Address - Street 1:3107 OAK CREEK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3025
Mailing Address - Country:US
Mailing Address - Phone:512-861-0700
Mailing Address - Fax:682-223-5560
Practice Address - Street 1:3107 OAK CREEK DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727
Practice Address - Country:US
Practice Address - Phone:512-861-0700
Practice Address - Fax:512-861-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130186261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical