Healthcare Provider Details

I. General information

NPI: 1497767149
Provider Name (Legal Business Name): PEARLAND PREMIER SURGERY CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 SMITH RANCH RD
PEARLAND TX
77584-5254
US

IV. Provider business mailing address

2813 SMITH RANCH RD
PEARLAND TX
77584-5254
US

V. Phone/Fax

Practice location:
  • Phone: 713-436-8844
  • Fax: 713-436-8161
Mailing address:
  • Phone: 713-436-8844
  • Fax: 713-436-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008304
License Number StateTX

VIII. Authorized Official

Name: DR. NIZAR CHARAFEDDINE
Title or Position: MD
Credential: M.D.
Phone: 713-436-8844