Provider Demographics
NPI:1598769481
Name:MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
Other - Org Name:DOCTORS UNITED SURGERY CENTER
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 1:12700 N FEATHERWOOD DR
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4439
Mailing Address - Country:US
Mailing Address - Phone:281-481-9303
Mailing Address - Fax:281-481-4263
Practice Address - Street 1:5146 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2054
Practice Address - Country:US
Practice Address - Phone:281-481-9303
Practice Address - Fax:281-481-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007115261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87973601Medicaid
TX490004300OtherRAILROAD MEDICARE
TX87973601Medicaid
TX45C0001077Medicare Oscar/Certification