Provider Demographics
NPI:1821045592
Name:UNIVERSITY GENERAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:UNIVERSITY GENERAL HOSPITAL, LLC
Other - Org Name:FOUNDATION SURGICAL HOSPITAL OF HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRALY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-608-1728
Mailing Address - Street 1:13900 N PORTLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4042
Mailing Address - Country:US
Mailing Address - Phone:405-608-1766
Mailing Address - Fax:405-608-1866
Practice Address - Street 1:7501 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1938
Practice Address - Country:US
Practice Address - Phone:713-375-7000
Practice Address - Fax:713-375-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-0019Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER