Healthcare Provider Details

I. General information

NPI: 1669700118
Provider Name (Legal Business Name): FWY NSG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 KATY FWY STE 202
HOUSTON TX
77055-7443
US

IV. Provider business mailing address

12121 RICHMOND AVE STE 324
HOUSTON TX
77082-2437
US

V. Phone/Fax

Practice location:
  • Phone: 713-647-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. GARY E KRAUS
Title or Position: MANAGER
Credential:
Phone: 281-870-9292