Healthcare Provider Details

I. General information

NPI: 1346573722
Provider Name (Legal Business Name): WESTGREEN AMBULATORY SURGICAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WESTGREEN BLVD
KATY TX
77450-2799
US

IV. Provider business mailing address

750 WESTGREEN BLVD
KATY TX
77450-2799
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-3937
  • Fax: 281-392-8671
Mailing address:
  • Phone: 281-392-3937
  • Fax: 281-392-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number130058
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number130058
License Number StateTX

VIII. Authorized Official

Name: MR. JIMMY PRICE
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 713-275-2457