Healthcare Provider Details

I. General information

NPI: 1831577451
Provider Name (Legal Business Name): NORTHWEST SURGICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17823 SERENE SHORE DR
CYPRESS TX
77429-5485
US

IV. Provider business mailing address

17823 SERENE SHORE DR
CYPRESS TX
77429-5485
US

V. Phone/Fax

Practice location:
  • Phone: 713-819-7225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOLLY BAKER
Title or Position: CSA
Credential:
Phone: 713-819-7225