Provider Demographics
NPI:1407122245
Name:HOME SURGICAL PA
Entity Type:Organization
Organization Name:HOME SURGICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:URI
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-885-5885
Mailing Address - Street 1:5600 KIRBY DR
Mailing Address - Street 2:SUITE S
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2449
Mailing Address - Country:US
Mailing Address - Phone:713-885-5885
Mailing Address - Fax:
Practice Address - Street 1:2429 BISSONNET ST
Practice Address - Street 2:SUITE 467
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1451
Practice Address - Country:US
Practice Address - Phone:713-885-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0039208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty