1689062135 NPI number — SURGICAL SPECIALISTS OF CONROE, PLLC

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 1689062135 NPI number — SURGICAL SPECIALISTS OF CONROE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SPECIALISTS OF CONROE, PLLC
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:
1689062135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 218
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304-2889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-756-2229
Provider Business Mailing Address Fax Number:
844-274-2115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-2889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-756-2229
Provider Business Practice Location Address Fax Number:
844-274-2115
Provider Enumeration Date:
01/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
713-852-1500

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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