Provider Demographics
NPI:1225127806
Name:WILLOWBROOK SURGERY CENTER LTD
Entity Type:Organization
Organization Name:WILLOWBROOK SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-955-2175
Mailing Address - Street 1:13300 HARGRAVE
Mailing Address - Street 2:#310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:281-955-2175
Mailing Address - Fax:281-955-8875
Practice Address - Street 1:13300 HARGRAVE
Practice Address - Street 2:#310
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-955-2175
Practice Address - Fax:281-955-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008301261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH095AOtherBLUE CROSS BLUE SHIELD
TXASC279Medicare ID - Type Unspecified