Provider Demographics
NPI:1346573722
Name:WESTGREEN AMBULATORY SURGICAL CENTER, PLLC
Entity Type:Organization
Organization Name:WESTGREEN AMBULATORY SURGICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2457
Mailing Address - Street 1:750 WESTGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2799
Mailing Address - Country:US
Mailing Address - Phone:281-392-3937
Mailing Address - Fax:281-392-8671
Practice Address - Street 1:750 WESTGREEN BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2799
Practice Address - Country:US
Practice Address - Phone:281-392-3937
Practice Address - Fax:281-392-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130058261QA1903X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45C0001527Medicare Oscar/Certification
TXASC451Medicare PIN