Provider Demographics
NPI:1437523834
Name:CRENSHAW AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:CRENSHAW AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-230-0836
Mailing Address - Street 1:5150 CRENSHAW ROAD
Mailing Address - Street 2:SUITE H 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3094
Mailing Address - Country:US
Mailing Address - Phone:832-230-0836
Mailing Address - Fax:832-598-2793
Practice Address - Street 1:5150 CRENSHAW ROAD
Practice Address - Street 2:SUITE H 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3094
Practice Address - Country:US
Practice Address - Phone:832-230-0836
Practice Address - Fax:832-598-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical