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General NPI Number Information
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NPI Number | 1073880530
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Entity Type | Organization
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Legal Business Name | KIRBY GLEN SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 2459 S BRAESWOOD BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4305
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Country | US
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Telephone | 713-529-8600
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Fax | 713-529-8603
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Provider Business Mailing Address
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Address Line | 14000 N PORTLAND AVE SUITE 203
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-4003
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Country | US
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Telephone | 405-608-1766
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Fax | 405-608-1866
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Authorized Official
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Title or Position | GENERAL COUNSEL / VP LEGAL SERVICES
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Name | MARCELO M PUIGGARI
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Credential | JD
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Telephone | 405-608-1735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007897
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License Number State | TX
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