Provider Demographics
NPI:1073880530
Name:KIRBY GLEN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:KIRBY GLEN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL / VP LEGAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUIGGARI
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:405-608-1735
Mailing Address - Street 1:14000 N PORTLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4003
Mailing Address - Country:US
Mailing Address - Phone:405-608-1766
Mailing Address - Fax:405-608-1866
Practice Address - Street 1:2459 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4305
Practice Address - Country:US
Practice Address - Phone:713-529-8600
Practice Address - Fax:713-529-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007897261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical