Basic Information
| Provider Information | |||||||||
| NPI: | 1740231489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONEGATE SURGERY CENTER LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W WILLIAM CANNON DR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124167246 | ||||||||
| FaxNumber: | 5124166791 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W WILLIAM CANNON DR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124167246 | ||||||||
| FaxNumber: | 5124166791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILLS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5124167246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 008385 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.