Provider Demographics
NPI:1659594190
Name:PSA AMBULATORY SURGICAL CENTER OF AUSTIN LLC
Entity type:Organization
Organization Name:PSA AMBULATORY SURGICAL CENTER OF AUSTIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-485-7200
Mailing Address - Street 1:PO BOX 208373
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8373
Mailing Address - Country:US
Mailing Address - Phone:512-485-7208
Mailing Address - Fax:844-364-8678
Practice Address - Street 1:4100 DUVAL ROAD
Practice Address - Street 2:BLDG 3 STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:855-876-7246
Practice Address - Fax:558-277-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64144261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC343Medicare PIN