1043697907 NPI number — SOUTHWEST FREEWAY SURGERY CENTER, LLC

Table of content: SHANA KAY CALDWELL RN, MSN, CPNP (NPI 1336200682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043697907 NPI number — SOUTHWEST FREEWAY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST FREEWAY SURGERY CENTER, 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:
6
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:
1043697907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4120 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77027-7339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-355-8614
Provider Business Mailing Address Fax Number:
713-355-8615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4120 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-7339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-355-8600
Provider Business Practice Location Address Fax Number:
713-355-8615
Provider Enumeration Date:
04/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
713-355-8600

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  130234 , 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)





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