Provider Demographics
NPI:1700913324
Name:MEMORIAL CITY SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:MEMORIAL CITY SURGICAL ASSOCIATES
Other - Org Name:MEMORIAL AND KATY SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:713-464-1981
Mailing Address - Street 1:1140 BUSINESS CENTER DR
Mailing Address - Street 2:400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-464-1981
Mailing Address - Fax:713-464-1131
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-464-1981
Practice Address - Fax:713-464-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A43JOtherBCBS TX
TX08154801Medicaid
TX08154801Medicaid
TX00A43JMedicare PIN