Provider Demographics
NPI:1427413145
Name:MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
Other - Org Name:DOCTORS UNITED SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIA
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:3534 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1728
Mailing Address - Country:US
Mailing Address - Phone:713-947-0330
Mailing Address - Fax:713-947-6562
Practice Address - Street 1:3534 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1728
Practice Address - Country:US
Practice Address - Phone:713-947-0330
Practice Address - Fax:713-947-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130288OtherSTATE LICENSE