Provider Demographics
NPI:1598096802
Name:MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC
Other - Org Name:MEMORIAL HERMANN MEMORIAL VILLAGE SURGERY CENTER
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 1:1120 BUSINESS CENTER DR
Mailing Address - Street 2:STE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2735
Mailing Address - Country:US
Mailing Address - Phone:713-337-1111
Mailing Address - Fax:713-337-1112
Practice Address - Street 1:1120 BUSINESS CENTER DR
Practice Address - Street 2:STE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2735
Practice Address - Country:US
Practice Address - Phone:713-337-1111
Practice Address - Fax:713-337-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130143261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC431Medicare PIN
TX45C0001513Medicare Oscar/Certification