Provider Demographics
NPI:1710460191
Name:WESLAYAN SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:WESLAYAN SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIM
Authorized Official - Middle Name:X
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-209-1210
Mailing Address - Street 1:4126 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7316
Mailing Address - Country:US
Mailing Address - Phone:832-209-1210
Mailing Address - Fax:832-690-4899
Practice Address - Street 1:4126 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7316
Practice Address - Country:US
Practice Address - Phone:832-209-1210
Practice Address - Fax:832-690-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherPRIVATE INS.