Provider Demographics
NPI:1578593224
Name:K S MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:K S MANAGEMENT SERVICES LLC
Other - Org Name:KELSEY-SEYBOLD ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTHELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-442-0000
Mailing Address - Street 1:2617C W HOLCOMBE BLVD
Mailing Address - Street 2:PMB 312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1601
Mailing Address - Country:US
Mailing Address - Phone:713-442-3300
Mailing Address - Fax:713-442-5833
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:ASC, 3RD FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-3300
Practice Address - Fax:713-442-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007124261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1504OtherBCBS PROVIDER ID
TXASC074Medicare PIN