Healthcare Provider Details

I. General information

NPI: 1417172891
Provider Name (Legal Business Name): CRYSTAL OUTPATIENT SURGERY CENTER LAKE JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 OAK DRIVE SOUTH SUITE J
HOUSTON TX
77024
US

IV. Provider business mailing address

10565 KATY FREEWAY SUITE 100
HOUSTON TX
77024
US

V. Phone/Fax

Practice location:
  • Phone: 713-467-9413
  • Fax:
Mailing address:
  • Phone: 713-467-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number000269
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT SCOTT YARISH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 713-467-0146