1376857326 NPI number — KB SURGERY NORTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376857326 NPI number — KB SURGERY NORTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KB SURGERY NORTH, 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:
Provider Other Organization Name Type Code:
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:
1376857326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5120 WOODWAY DR STE 7012
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:
77056-1791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 FM 1960 BYPASS RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-964-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANAGEMENT
Authorized Official First Name:
ACCESS
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT MANAGEMENT
Authorized Official Telephone Number:
713-532-7311

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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