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General NPI Number Information
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NPI Number | 1114264488
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Entity Type | Organization
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Legal Business Name | EXECUTIVE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 13603 MICHEL RD
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City | TOMBALL
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State | TX
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Zip | 77375-6410
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Country | US
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Telephone | 832-698-3720
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Fax | 832-698-3721
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Provider Business Mailing Address
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Address Line | 13603 MICHEL RD SUITE 100
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City | TOMBALL
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State | TX
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Zip | 77375
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Country | US
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Telephone | 832-698-3720
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Fax | 832-698-3721
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MOHAMMED TAREK AL-FAHL
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Credential | MD
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Telephone | 832-698-3720
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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 |
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License Number State |
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