Provider Demographics
NPI:1841785292
Name:WESTSIDE SURGICAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:WESTSIDE SURGICAL HOSPITAL, LLC
Other - Org Name:WESTSIDE SURGICAL HOSPITAL - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGGUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-1711
Mailing Address - Street 1:5120 WOODWAY DR STE 7012
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1791
Mailing Address - Country:US
Mailing Address - Phone:713-660-1700
Mailing Address - Fax:
Practice Address - Street 1:4200 TWELVE OAKS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6812
Practice Address - Country:US
Practice Address - Phone:713-621-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory