Provider Demographics
NPI:1811970494
Name:FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON LLC
Entity type:Organization
Organization Name:FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MBA,CASC
Authorized Official - Phone:713-272-6300
Mailing Address - Street 1:8111 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1705
Mailing Address - Country:US
Mailing Address - Phone:713-272-6300
Mailing Address - Fax:713-272-8532
Practice Address - Street 1:8111 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1705
Practice Address - Country:US
Practice Address - Phone:713-272-6300
Practice Address - Fax:713-272-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007215261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20526OtherPHARMACY LICENSE
TX0879868-01Medicaid
TX007215OtherFACILITY LICENSE
TX20117145OtherDPS
TXASC091OtherMEDICARE
721500OtherTHCIC
BD 6933558OtherDEA