Healthcare Provider Details

I. General information

NPI: 1366841090
Provider Name (Legal Business Name): WESTMONT CHILDRENS AMBULATORY SURGERY CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 CAIRNWAY DR
HOUSTON TX
77084-3562
US

IV. Provider business mailing address

16100 CAIRNWAY DR
HOUSTON TX
77084-3562
US

V. Phone/Fax

Practice location:
  • Phone: 714-683-2970
  • Fax: 714-683-0925
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number25277
License Number StateTX

VIII. Authorized Official

Name: JAMAL ANAIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-739-5959