Healthcare Provider Details

I. General information

NPI: 1326444688
Provider Name (Legal Business Name): BRYAN COLLEGE STATION ASC, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 UNIVERSITY DR E STE 430
BRYAN TX
77802-3486
US

IV. Provider business mailing address

DEPT# 6020, PO BOX 4417
HOUSTON TX
77210-4417
US

V. Phone/Fax

Practice location:
  • Phone: 979-485-9922
  • Fax: 979-485-9923
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY MARIE BEMIS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 858-722-2358