Provider Demographics
NPI:1255600508
Name:CREEKSIDE SURGICAL
Entity type:Organization
Organization Name:CREEKSIDE SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSO MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-407-6855
Mailing Address - Street 1:8900 SHOAL CREEK BLVD
Mailing Address - Street 2:BLDG 301B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6810
Mailing Address - Country:US
Mailing Address - Phone:512-407-6855
Mailing Address - Fax:512-524-2251
Practice Address - Street 1:8900 SHOAL CREEK BLVD
Practice Address - Street 2:BLDG 301B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6810
Practice Address - Country:US
Practice Address - Phone:512-407-6855
Practice Address - Fax:512-524-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6973207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty