Provider Demographics
NPI:1336391085
Name:MEMORIAL HERMANN SURGERY CENTER KINGSLAND LLC
Entity type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER KINGSLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-729-4009
Mailing Address - Street 1:21720 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2550
Mailing Address - Country:US
Mailing Address - Phone:281-492-1234
Mailing Address - Fax:281-579-5630
Practice Address - Street 1:21720 KINGSLAND BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2550
Practice Address - Country:US
Practice Address - Phone:281-492-1234
Practice Address - Fax:281-579-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130003261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00744720OtherRAILROAD MEDICARE
TXASC379Medicare PIN
TX45C0001442Medicare Oscar/Certification