Provider Demographics
NPI:1659760627
Name:CENTER FOR ADVANCED SURGICAL TREATMENT, LLC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED SURGICAL TREATMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:713-305-2307
Mailing Address - Street 1:7830 W GRAND PKWY S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7830 W GRAND PKWY S
Practice Address - Street 2:SUITE 150
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5816
Practice Address - Country:US
Practice Address - Phone:713-305-2307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ENDOSCOPIC SPINE SURGERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical