Provider Demographics
NPI:1154526044
Name:KERRVILLE AMBULATORY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:KERRVILLE AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-257-4417
Mailing Address - Street 1:PO BOX 294868
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4868
Mailing Address - Country:US
Mailing Address - Phone:830-896-2444
Mailing Address - Fax:830-896-2447
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:UNIT C
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3523
Practice Address - Country:US
Practice Address - Phone:830-896-2444
Practice Address - Fax:830-896-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008616261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197547601Medicaid
TXH0HH171A01OtherBCBS
TX197547601Medicaid