Provider Demographics
NPI:1952331092
Name:MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP
Entity Type:Organization
Organization Name:MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:17510 W GRAND PKWY S
Mailing Address - Street 2:STE 200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2645
Mailing Address - Country:US
Mailing Address - Phone:281-238-1600
Mailing Address - Fax:281-238-1650
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:STE 200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-238-1600
Practice Address - Fax:281-238-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8395261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170389401Medicaid
TX7100440572OtherRAILROAD MEDICARE
TX170389401Medicaid
TX45C0001449Medicare Oscar/Certification