Provider Demographics
NPI:1518344043
Name:MEMORIAL HERMANN SURGERY CENTER KIRBY, LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER KIRBY, LLC
Other - Org Name:MEMORIAL HERMANN SURGERY CENTER KIRBY GLEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
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 1:2459 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4305
Mailing Address - Country:US
Mailing Address - Phone:713-529-8600
Mailing Address - Fax:713-529-8603
Practice Address - Street 1:2459 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4305
Practice Address - Country:US
Practice Address - Phone:713-529-8600
Practice Address - Fax:713-529-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical