Provider Demographics
NPI:1952180002
Name:LAKE TRAVIS SURGERY CENTER
Entity Type:Organization
Organization Name:LAKE TRAVIS SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, JD
Authorized Official - Phone:512-769-7964
Mailing Address - Street 1:12528 RUSH CREEK LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1991
Mailing Address - Country:US
Mailing Address - Phone:512-769-7964
Mailing Address - Fax:
Practice Address - Street 1:6 LAKEWAY CENTRE COURT
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734
Practice Address - Country:US
Practice Address - Phone:512-769-7964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty