Healthcare Provider Details

I. General information

NPI: 1265104822
Provider Name (Legal Business Name): AENT ASC 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10847 KUYKENDAHL RD STE 150
SPRING TX
77382-2934
US

IV. Provider business mailing address

450 GEARS RD STE 420
HOUSTON TX
77067-4529
US

V. Phone/Fax

Practice location:
  • Phone: 281-875-8428
  • Fax: 281-874-0018
Mailing address:
  • Phone: 281-875-8428
  • Fax:

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: ENRIQUE QUINTERO
Title or Position: MANAGER
Credential: MD
Phone: 281-701-5550