Provider Demographics
NPI:1073837290
Name:ASP WORTHAM SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ASP WORTHAM SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-554-7500
Mailing Address - Street 1:13114 FM 1960 RD W
Mailing Address - Street 2:SUITE 118
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4290
Mailing Address - Country:US
Mailing Address - Phone:713-559-9100
Mailing Address - Fax:713-559-9109
Practice Address - Street 1:13114 FM 1960 RD W
Practice Address - Street 2:SUITE 118
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4290
Practice Address - Country:US
Practice Address - Phone:713-559-9100
Practice Address - Fax:713-559-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130052261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical