Organization
MEDICAL PARK TOWER SURGERY CENTER, LLC
Active
Other names
Medical Park Tower Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
PETER BLACH (OFFICER/AUTHORIZED OFFICIAL)
(713) 343-0832
Entity
Organization
Contact information
Practice address
1301 W 38TH ST, STE 109, AUSTIN, TX 78705-1000
(512) 354-3000
(512) 354-3009
Mailing address
1301 W 38TH ST, STE 109, AUSTIN, TX 78705-1010
(512) 354-3000
(512) 354-3009
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
130050
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2945552
—
TX
01
—
P00928912
RAILROAD MEDICARE
TX
Enumeration date
03/24/2010
Last updated
10/11/2024
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