Healthcare Provider Details
I. General information
NPI: 1457876898
Provider Name (Legal Business Name): MVP SPECIALIST SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/07/2017
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7501 FANNIN ST STE 200
HOUSTON TX
77054-1953
US
IV. Provider business mailing address
PO BOX 735192
DALLAS TX
75373-5192
US
V. Phone/Fax
- Phone: 713-244-5721
- Fax: 713-487-1523
- Phone: 713-244-5721
- Fax: 713-487-1523
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QA1903X |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
JUANITTA
FRANCIS
Title or Position: GOVERNING MEMBER
Credential:
Phone: 713-244-5721