Texas Health and Safety Code Sec. § 243.003 License Required (a) Except as provided by Section 243.004 (Exemptions From Licensing Requirement), a person may not establish or operate an ambulatory surgical center in this state without a license issued under this chapter. (b) Each ambulatory surgical center must have a separate license. (c) A license is not transferable or assignable. Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.