Provider Demographics
NPI:1396175246
Name:MEMORIAL HERMANN BAY AREA ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:MEMORIAL HERMANN BAY AREA ENDOSCOPY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-729-4009
Mailing Address - Street 1:444 FM 1959 RD
Mailing Address - Street 2:STE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5416
Mailing Address - Country:US
Mailing Address - Phone:281-892-2420
Mailing Address - Fax:281-892-2448
Practice Address - Street 1:444 FM 1959 RD
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-5416
Practice Address - Country:US
Practice Address - Phone:281-892-2420
Practice Address - Fax:281-892-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130176261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX490003277OtherRAILROAD MEDICARE
TX345893701Medicaid
TX45C0001194Medicare Oscar/Certification
TX365555Medicare PIN