Provider Demographics
NPI:1851368997
Name:MEDICAL CENTER SURGICAL SHOP
Entity Type:Organization
Organization Name:MEDICAL CENTER SURGICAL SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ICENHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-666-9022
Mailing Address - Street 1:5313 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3903
Mailing Address - Country:US
Mailing Address - Phone:713-666-9022
Mailing Address - Fax:713-666-9386
Practice Address - Street 1:5313 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3903
Practice Address - Country:US
Practice Address - Phone:713-666-9022
Practice Address - Fax:713-666-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0075417332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0441820001Medicare UPIN