Healthcare Provider Details

I. General information

NPI: 1609006113
Provider Name (Legal Business Name): OPREX SURGERY (HOUSTON)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 TOWN PARK DR
HOUSTON TX
77036-2343
US

IV. Provider business mailing address

PO BOX 721684
HOUSTON TX
77272-1684
US

V. Phone/Fax

Practice location:
  • Phone: 713-960-6692
  • Fax: 713-960-6691
Mailing address:
  • Phone: 713-960-6692
  • Fax: 713-960-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number130010
License Number StateTX

VIII. Authorized Official

Name: KRAIG KILLOUGH
Title or Position: MANAGER
Credential:
Phone: 713-960-6692