Provider Demographics
NPI:1497312540
Name:MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:7515 MAIN ST STE 800
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4518
Mailing Address - Country:US
Mailing Address - Phone:713-799-9990
Mailing Address - Fax:713-796-1142
Practice Address - Street 1:7515 MAIN ST STE 800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4518
Practice Address - Country:US
Practice Address - Phone:713-799-9990
Practice Address - Fax:713-796-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical