Provider Demographics
NPI:1407306285
Name:TEXAS MENSA NEUROSURGERY MANAGEMENT
Entity Type:Organization
Organization Name:TEXAS MENSA NEUROSURGERY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRIERSON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-451-9031
Mailing Address - Street 1:9550 SPRING GREEN BLVD
Mailing Address - Street 2:SUITE 408-358
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3758
Mailing Address - Country:US
Mailing Address - Phone:832-451-9031
Mailing Address - Fax:832-437-2915
Practice Address - Street 1:9550 SPRING GREEN BLVD
Practice Address - Street 2:SUITE 408-358
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3758
Practice Address - Country:US
Practice Address - Phone:832-451-9031
Practice Address - Fax:832-437-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXSA0098251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXSA0098OtherSURGICAL ASSISTANT