Healthcare Provider Details

I. General information

NPI: 1629725551
Provider Name (Legal Business Name): MIDTOWN SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 RICHMOND AVE STE 200
HOUSTON TX
77057-6321
US

IV. Provider business mailing address

5959 RICHMOND AVE STE 200
HOUSTON TX
77057-6321
US

V. Phone/Fax

Practice location:
  • Phone: 832-816-8693
  • Fax:
Mailing address:
  • Phone: 832-816-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAMONT RATCLIFF
Title or Position: CEO
Credential:
Phone: 832-816-8693