Provider Demographics
NPI:1497767149
Name:PEARLAND PREMIER SURGERY CENTER, LTD
Entity Type:Organization
Organization Name:PEARLAND PREMIER SURGERY CENTER, LTD
Other - Org Name:PEARLAND PREMIER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARAFEDDINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-436-8844
Mailing Address - Street 1:2813 SMITH RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5254
Mailing Address - Country:US
Mailing Address - Phone:713-436-8844
Mailing Address - Fax:713-436-8161
Practice Address - Street 1:2813 SMITH RANCH RD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5254
Practice Address - Country:US
Practice Address - Phone:713-436-8844
Practice Address - Fax:713-436-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008304261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450001418Medicare ID - Type Unspecified