1124319868 NPI number — WEST COAST SURGICAL, LTD

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 1124319868 NPI number — WEST COAST SURGICAL, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST SURGICAL, LTD
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:
1124319868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18557
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77496-8557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-969-8738
Provider Business Mailing Address Fax Number:
281-969-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 CARTWRIGHT RD
Provider Second Line Business Practice Location Address:
SUITE 606
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-969-8738
Provider Business Practice Location Address Fax Number:
281-969-8882
Provider Enumeration Date:
04/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LABOME
Authorized Official First Name:
THEDA
Authorized Official Middle Name:
EDWARDS
Authorized Official Title or Position:
BUSINESS OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
281-969-8738

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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