Provider Demographics
NPI:1568662898
Name:MEMORIAL VILLAGE SURGERY CENTER
Entity Type:Organization
Organization Name:MEMORIAL VILLAGE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:NUNEZ
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:CASA
Authorized Official - Phone:713-337-1111
Mailing Address - Street 1:12727 KIMBERLEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4048
Mailing Address - Country:US
Mailing Address - Phone:713-337-1111
Mailing Address - Fax:
Practice Address - Street 1:12727 KIMBERLEY LN STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4048
Practice Address - Country:US
Practice Address - Phone:713-337-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451208OtherMEDICARE