Provider Demographics
NPI:1821877911
Name:SURGICAL REHABILITATION CENTER
Entity Type:Organization
Organization Name:SURGICAL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHUKWUEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-724-0794
Mailing Address - Street 1:612 S. TWIN CITY HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627
Mailing Address - Country:US
Mailing Address - Phone:409-724-0794
Mailing Address - Fax:409-724-7821
Practice Address - Street 1:612 S. TWIN CITY HWY
Practice Address - Street 2:SUITE B
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627
Practice Address - Country:US
Practice Address - Phone:409-724-0794
Practice Address - Fax:409-724-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery