Healthcare Provider Details

I. General information

NPI: 1295188738
Provider Name (Legal Business Name): HUMBLE SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 FM 2920 RD SUITE A
SPRING TX
77388-3676
US

IV. Provider business mailing address

5120 WOODWAY DR STE 7012
HOUSTON TX
77056-1791
US

V. Phone/Fax

Practice location:
  • Phone: 713-532-7311
  • Fax:
Mailing address:
  • Phone: 713-532-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAR KIGGUNDU
Title or Position: MANAGING MEMBER
Credential:
Phone: 713-532-7311