Provider Demographics
NPI:1083991582
Name:GROGAN'S MILL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GROGAN'S MILL SURGERY CENTER, LLC
Other - Org Name:CREEKSIDE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-292-5620
Mailing Address - Street 1:10847 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2777
Mailing Address - Country:US
Mailing Address - Phone:281-292-5620
Mailing Address - Fax:
Practice Address - Street 1:10847 KUYKENDAHL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2777
Practice Address - Country:US
Practice Address - Phone:281-292-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical