Healthcare Provider Details

I. General information

NPI: 1063870012
Provider Name (Legal Business Name): AIP PROCEDURE SUITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21830 KINGSLAND BLVD STE 102
KATY TX
77450-2500
US

IV. Provider business mailing address

1544 SAWDUST RD SUITE 280
SPRING TX
77380-2929
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-7411
  • Fax: 281-292-7481
Mailing address:
  • Phone: 281-292-7411
  • Fax: 281-292-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM OLSAN
Title or Position: OWNER
Credential:
Phone: 281-292-7411