Provider Demographics
NPI:1164724373
Name:HOUSTON MICROSURGERY INSTITUTE, LLC
Entity Type:Organization
Organization Name:HOUSTON MICROSURGERY INSTITUTE, LLC
Other - Org Name:MICROSURGERY INSTITUTE OF HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-355-8600
Mailing Address - Street 1:4120 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-355-8600
Mailing Address - Fax:713-355-8069
Practice Address - Street 1:4120 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-355-8600
Practice Address - Fax:713-355-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45C0001346Medicare Oscar/Certification