Provider Demographics
NPI:1326710401
Name:TEXAS INSTITUTE OF SPECIALIZED SURGERY, LLC
Entity Type:Organization
Organization Name:TEXAS INSTITUTE OF SPECIALIZED SURGERY, LLC
Other - Org Name:LEGENT INSTITUTE FOR SPECIALIZED SUGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-6285
Mailing Address - Street 1:1006 WINDSOR LAKES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4974
Mailing Address - Country:US
Mailing Address - Phone:346-980-1204
Mailing Address - Fax:281-962-6593
Practice Address - Street 1:1006 WINDSOR LAKES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4974
Practice Address - Country:US
Practice Address - Phone:346-389-2810
Practice Address - Fax:281-962-6593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS INSTITUTE OF SPECIALIZED SURGER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-28
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical