Provider Demographics
NPI:1164875365
Name:NEUROSURGERY OF KINGWOOD, PLLC
Entity Type:Organization
Organization Name:NEUROSURGERY OF KINGWOOD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1550
Mailing Address - Street 1:22999 HIGHWAY 59 N STE 220
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4440
Mailing Address - Country:US
Mailing Address - Phone:281-312-6457
Mailing Address - Fax:281-312-5128
Practice Address - Street 1:22999 HIGHWAY 59 N STE 220
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4440
Practice Address - Country:US
Practice Address - Phone:281-312-6457
Practice Address - Fax:281-312-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty