Provider Demographics
NPI:1083644124
Name:MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP
Other - Org Name:MEMORIAL HERMANN SURGERY CENTER SOUTHWEST
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:7789 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-343-3100
Mailing Address - Fax:713-343-3156
Practice Address - Street 1:7789 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-343-3100
Practice Address - Fax:713-343-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008394261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC332Medicare PIN
TX45C00001443Medicare Oscar/Certification