Provider Demographics
NPI:1356479935
Name:MBC AMBULATORY SURGERY CENTER LP
Entity Type:Organization
Organization Name:MBC AMBULATORY SURGERY CENTER LP
Other - Org Name:MANN CATARACT SURGERY CENTER MAIN HUMBLE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2457
Mailing Address - Street 1:18850 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4288
Mailing Address - Country:US
Mailing Address - Phone:713-275-2457
Mailing Address - Fax:713-275-2466
Practice Address - Street 1:18850 S MEMORIAL DR
Practice Address - Street 2:5115 MAIN ST. #300 HOUSTON, TEXAS 77002
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4288
Practice Address - Country:US
Practice Address - Phone:713-275-2457
Practice Address - Fax:713-275-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC354OtherMEDICARE PTAN
TXHH1286OtherBLUE CROSS
TXASC072Medicare ID - Type Unspecified