Basic Information
| Provider Information | |||||||||
| NPI: | 1962459610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL TEXAS DAY SURGERY CENTER LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 S W S YOUNG DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765423311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542459177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 S W S YOUNG DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765423340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542130489 | ||||||||
| FaxNumber: | 2542137771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | IRVINE | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2542130489 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 130129 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 102774100 | 01 | TX | FIRST CARE | OTHER | 490000381 | 01 | TX | CARE | OTHER | HH1256 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 49004797 | 01 | TX | PALMETTO GBA | OTHER | 085869801 | 05 | TX | MEDICAID |