Provider Demographics
NPI:1366827958
Name:WEST GRAY CENTER FOR SPECIAL SURGERY, LLC
Entity Type:Organization
Organization Name:WEST GRAY CENTER FOR SPECIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:713-522-5111
Mailing Address - Street 1:1355 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4019
Mailing Address - Country:US
Mailing Address - Phone:713-522-5111
Mailing Address - Fax:713-522-6111
Practice Address - Street 1:1355 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4019
Practice Address - Country:US
Practice Address - Phone:713-522-5111
Practice Address - Fax:713-522-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical