Psa Ambulatory Surgery Center of Killeen LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PSA AMBULATORY SURGERY CENTER OF KILLEEN LLC

Practice address

2701 E. Stan Schlueter Loop
Killeen, TX 76542

Phone

(512) 485-7200

NPI assigned

Sep 19, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Davelyn Mahoney

Title

Credentialing Manager

Phone

(512) 485-7208

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Psa Ambulatory Surgery Center of Killeen LLCCCN 45C0001569

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1003166844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 208367",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753208367",
            "telephone_number": "512-485-7208",
            "fax_number": "844-264-8678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 E. STAN SCHLUETER LOOP",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76542",
            "telephone_number": "512-485-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSA AMBULATORY SURGERY CENTER OF KILLEEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "MAHONEY",
        "authorized_official_first_name": "DAVELYN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "512-485-7208",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Counseling Associates PLLC
• Professional Counseling Service
• Protherapy Solutions
• Susan M. Provost-Danner, OTR
• Maria A. Provost, MD
• Gary Pundt, D.D.S.
• Wayne Ervin Pundt, D.D.S
• Emily Purcell, M.A., SLP
• Quianna Jazmone Purham
• Shawn K Puri, M.D.

• Ambulatory Surgical Clinic/Center in Killeen, TX
• Providers in Killeen, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.