Healthcare Provider Details

I. General information

NPI: 1124894423
Provider Name (Legal Business Name): KS SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 05/21/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22407 HOLZWARTH ROAD
SPRING TX
77389-1917
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY CENTRAL BUSINESS OFFICE (ASC)
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 346-674-4000
  • Fax:
Mailing address:
  • Phone: 713-442-5669
  • Fax: 713-442-2760

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: JULIE BURCH GARCIA
Title or Position: SR DIRECTOR, REVENUE CYCLE MGMT
Credential:
Phone: 713-442-5027