Healthcare Provider Details

I. General information

NPI: 1013962380
Provider Name (Legal Business Name): WOODLANDS ENDOSCOPY CENTR, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VISION PARK BLVD SUITE 160
SHENANDOAH TX
77384-3002
US

IV. Provider business mailing address

111 VISION PARK BLVD SUITE 160
SHENANDOAH TX
77384-3002
US

V. Phone/Fax

Practice location:
  • Phone: 936-321-8910
  • Fax: 936-321-8913
Mailing address:
  • Phone: 936-321-8910
  • Fax: 936-321-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number008224
License Number StateTX

VIII. Authorized Official

Name: MR. CHRISTOPHER A HOLDEN
Title or Position: CHIEF MANAGER OF LLC
Credential:
Phone: 615-665-1283