Provider Demographics
NPI:1669467528
Name:DICKINSON SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:DICKINSON SURGERY CENTER, L.L.C.
Other - Org Name:HOUSTON PHYSICIAN'S SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, NUETERRA
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TASSET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-387-0510
Mailing Address - Street 1:3810 HUGHES CT
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6205
Mailing Address - Country:US
Mailing Address - Phone:281-557-5622
Mailing Address - Fax:
Practice Address - Street 1:3810 HUGHES CT
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6205
Practice Address - Country:US
Practice Address - Phone:281-337-7001
Practice Address - Fax:281-337-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007170261Q00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC051Medicare PIN