Provider Demographics
NPI:1376790691
Name:MEMORIAL HERMANN ENDOSCOPY & SURGERY CENTER NORTH HOUSTON, LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN ENDOSCOPY & SURGERY CENTER NORTH HOUSTON, LLC
Other - Org Name:NORTH HOUSTON ENDOSCOPY & SURGERY
Other - Org Type:Doing Business As
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 1:14201 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2916
Mailing Address - Country:US
Mailing Address - Phone:281-440-5797
Mailing Address - Fax:281-586-8616
Practice Address - Street 1:275 LANTERN BEND DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2840
Practice Address - Country:US
Practice Address - Phone:281-440-5797
Practice Address - Fax:281-586-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008709261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45C0001298Medicare Oscar/Certification
TXASC384Medicare PIN