Provider Demographics
NPI:1811286875
Name:WHOLE WOMAN'S SURGICAL CENTER LLC
Entity type:Organization
Organization Name:WHOLE WOMAN'S SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-737-9615
Mailing Address - Street 1:8401 N I H 35
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5751
Mailing Address - Country:US
Mailing Address - Phone:512-835-6858
Mailing Address - Fax:888-724-3239
Practice Address - Street 1:4025 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3641
Practice Address - Country:US
Practice Address - Phone:210-281-4251
Practice Address - Fax:888-724-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26045261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical