Basic Information
Provider Information | |||||||||
NPI: | 1902302961 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HILL COUNTRY SURGERY CENTER, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SURGERY CENTER OF BOERNE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14201 DALLAS PKWY | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752542916 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9727633859 | ||||||||
FaxNumber: | 9729203445 | ||||||||
Practice Location | |||||||||
Address1: | 112 HERFF RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | BOERNE | ||||||||
State: | TX | ||||||||
PostalCode: | 780062748 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8303317700 | ||||||||
FaxNumber: | 8303317709 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/30/2018 | ||||||||
LastUpdateDate: | 01/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DANNA | ||||||||
AuthorizedOfficialFirstName: | TERESA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICER / AUTHORIZED OFFICIAL | ||||||||
AuthorizedOfficialTelephone: | 9727633890 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center |   | 261QA1903X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.