Healthcare Provider Details

I. General information

NPI: 1871050864
Provider Name (Legal Business Name): ALLIANCE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21155 SOUTHWEST FWY
RICHMOND TX
77469-7101
US

IV. Provider business mailing address

21155 SOUTHWEST FWY
RICHMOND TX
77469-7101
US

V. Phone/Fax

Practice location:
  • Phone: 281-810-1060
  • Fax: 281-810-1064
Mailing address:
  • Phone: 713-277-5679
  • Fax: 281-810-1064

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: MR. REGGIE ABRAHAM
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 713-277-5679