Healthcare Provider Details

I. General information

NPI: 1629367628
Provider Name (Legal Business Name): ROYAL SURGICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16605 SOUTHWEST FWY SUITE 510
SUGAR LAND TX
77479-3501
US

IV. Provider business mailing address

PO BOX 79666
HOUSTON TX
77279-9666
US

V. Phone/Fax

Practice location:
  • Phone: 832-532-7100
  • Fax: 832-532-7410
Mailing address:
  • Phone: 832-532-7100
  • Fax: 832-532-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: JAY M. SHENAQ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 832-532-7100