Provider Demographics
NPI:1871983965
Name:AUSTIN SURGICO
Entity type:Organization
Organization Name:AUSTIN SURGICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CRNA/HEAD OF ANESTHESIA/
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL-WASELENCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:512-413-2425
Mailing Address - Street 1:4701 BEE CAVES RD
Mailing Address - Street 2:203
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5366
Mailing Address - Country:US
Mailing Address - Phone:512-717-3114
Mailing Address - Fax:512-879-6866
Practice Address - Street 1:4701 BEE CAVES RD
Practice Address - Street 2:203
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5366
Practice Address - Country:US
Practice Address - Phone:512-717-3114
Practice Address - Fax:512-879-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48273261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical