1194215921 NPI number — ST. MARY AMBULATORY SURGERY CENTER

Table of content: (NPI 1194215921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194215921 NPI number — ST. MARY AMBULATORY SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY AMBULATORY SURGERY CENTER
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:
1194215921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 WINDSOR LAKE BLVD.
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-383-9693
Provider Business Mailing Address Fax Number:
832-610-2767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 WINDSOR LAKE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-537-8088
Provider Business Practice Location Address Fax Number:
832-610-2767
Provider Enumeration Date:
05/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BISHAI
Authorized Official First Name:
EMAD
Authorized Official Middle Name:
MIKHAIL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
917-340-8981

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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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