Provider Demographics
NPI:1033586136
Name:PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC
Other - Org Name:MEMORIAL HERMANN SURGERY CENTER PARK TEN
Other - Org Type:Doing Business As
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 1:15775 PARK TEN PL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5153
Mailing Address - Country:US
Mailing Address - Phone:281-647-2300
Mailing Address - Fax:281-550-7888
Practice Address - Street 1:15775 PARK TEN PL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5153
Practice Address - Country:US
Practice Address - Phone:281-647-2300
Practice Address - Fax:281-550-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical