Provider Demographics
NPI:1023002524
Name:RIVER OAKS SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:RIVER OAKS SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-626-8500
Mailing Address - Street 1:4120 SOUTHWEST FWY
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7339
Mailing Address - Country:US
Mailing Address - Phone:713-626-8500
Mailing Address - Fax:713-626-8560
Practice Address - Street 1:4120 SOUTHWEST FWY
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7339
Practice Address - Country:US
Practice Address - Phone:713-626-8500
Practice Address - Fax:713-626-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087948801Medicaid
TXASC019Medicare UPIN