Provider Demographics
NPI:1922018951
Name:FIRST SURGICAL MEMORIAL VILLAGE
Entity Type:Organization
Organization Name:FIRST SURGICAL MEMORIAL VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CASC
Authorized Official - Phone:713-665-1111
Mailing Address - Street 1:12727 KIMBERLEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4048
Mailing Address - Country:US
Mailing Address - Phone:713-337-1111
Mailing Address - Fax:713-337-1112
Practice Address - Street 1:12727 KIMBERLEY LN STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4048
Practice Address - Country:US
Practice Address - Phone:713-337-1111
Practice Address - Fax:713-337-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008358261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008358OtherTX DEPT. OF HEALTH