Provider Demographics
NPI:1346246840
Name:MEMORIAL HERMANN WEST HOUSTON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN WEST HOUSTON SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:970 CAMPBELL ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2804
Mailing Address - Country:US
Mailing Address - Phone:713-461-3547
Mailing Address - Fax:713-461-0754
Practice Address - Street 1:970 CAMPBELL ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2804
Practice Address - Country:US
Practice Address - Phone:713-461-3547
Practice Address - Fax:713-461-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000318261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1227OtherTX BCBS PROVIDER ID
TX085859901Medicaid
TXHH1227OtherTX BCBS PROVIDER ID
TX085859901Medicaid