Healthcare Provider Details

I. General information

NPI: 1306262522
Provider Name (Legal Business Name): VACLAW SURGICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 LAKE WOODLANDS DR
SPRING TX
77382-2565
US

IV. Provider business mailing address

3027 IVORY FOREST LN
SPRING TX
77386-3159
US

V. Phone/Fax

Practice location:
  • Phone: 281-363-7100
  • Fax:
Mailing address:
  • Phone:
  • 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: MARCIN VACLAW
Title or Position: MANAGING MEMBER
Credential:
Phone: 713-532-7311