Provider Demographics
NPI:1407165772
Name:MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY, LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY, LLC
Other - Org Name:MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:1441 WOODSTEAD CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1410
Mailing Address - Country:US
Mailing Address - Phone:281-825-4702
Mailing Address - Fax:281-363-0450
Practice Address - Street 1:1441 WOODSTEAD CT
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1410
Practice Address - Country:US
Practice Address - Phone:281-825-4702
Practice Address - Fax:281-363-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC424Medicare PIN