Provider Demographics
NPI:1992118525
Name:CENTRAL HOUSTON SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:CENTRAL HOUSTON SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIM
Authorized Official - Middle Name:X
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-571-1234
Mailing Address - Street 1:4126 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7310
Mailing Address - Country:US
Mailing Address - Phone:832-571-1234
Mailing Address - Fax:
Practice Address - Street 1:4126 SOUTHWEST FWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7310
Practice Address - Country:US
Practice Address - Phone:832-571-1234
Practice Address - Fax:832-571-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical