1811970494 NPI number — FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON LLC

Table of content: (NPI 1811970494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811970494 NPI number — FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOCTORS' SURGICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811970494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8111 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-272-6300
Provider Business Mailing Address Fax Number:
713-272-8532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8111 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-272-6300
Provider Business Practice Location Address Fax Number:
713-272-8532
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LERMA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-272-6300

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  007215 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20526 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0879868-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007215 . This is a "FACILITY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 20117145 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: ASC091 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721500 . This is a "THCIC" identifier . This identifiers is of the category "OTHER".




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