Healthcare Provider Details

I. General information

NPI: 1558579987
Provider Name (Legal Business Name): MEMORIAL ENT SURGICAL AFFILAITES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 OLD KATY RD SUITE 202
HOUSTON TX
77055-7454
US

IV. Provider business mailing address

9494 SOUTHWEST FWY SUITE 850
HOUSTON TX
77074-1419
US

V. Phone/Fax

Practice location:
  • Phone: 713-647-7700
  • Fax: 713-647-7702
Mailing address:
  • Phone: 713-541-4069
  • Fax: 713-484-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROY LEWIS
Title or Position: MANAGER
Credential: M.D.
Phone: 713-541-4069