Healthcare Provider Details

I. General information

NPI: 1124584263
Provider Name (Legal Business Name): STONERIDGE SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 LAKE WOODLANDS DR STE 165
THE WOODLANDS TX
77382-2565
US

IV. Provider business mailing address

6701 LAKE WOODLANDS DR STE 165
THE WOODLANDS TX
77382-2565
US

V. Phone/Fax

Practice location:
  • Phone: 281-825-4610
  • Fax: 832-442-3231
Mailing address:
  • Phone: 281-825-4610
  • Fax: 832-442-3231

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: MRS. LETTY DIAZ
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 281-825-4610