Provider Demographics
NPI:1558331801
Name:MEMORIAL HERMANN SURGERY CENTER - THE WOODLANDS, LLP
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER - THE WOODLANDS, LLP
Other - Org Name:MEMORIAL HERMANN SURGERY CENTER, THE WOODLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-729-4009
Mailing Address - Street 1:9200 PINECROFT DRIVE
Mailing Address - Street 2:SUITE 200 MOB III
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3282
Mailing Address - Country:US
Mailing Address - Phone:281-297-9500
Mailing Address - Fax:281-297-9501
Practice Address - Street 1:9200 PINECROFT DRIVE
Practice Address - Street 2:SUITE 200 MOB III
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3282
Practice Address - Country:US
Practice Address - Phone:281-297-9500
Practice Address - Fax:281-297-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008254261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186338301Medicaid
TXP00283907OtherRAILROAD MEDICARE
451406Medicare PIN
TX45C0001406Medicare Oscar/Certification