Provider Demographics
NPI:1902200785
Name:FIRST NOBILIS SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:FIRST NOBILIS SURGICAL CENTER, LLC
Other - Org Name:FIRST STREET SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-665-1111
Mailing Address - Street 1:4120 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7339
Mailing Address - Country:US
Mailing Address - Phone:713-665-1111
Mailing Address - Fax:713-355-8069
Practice Address - Street 1:411 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4027
Practice Address - Country:US
Practice Address - Phone:713-665-1111
Practice Address - Fax:713-355-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130207261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical