=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144579095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSD SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2012
-----------------------------------------------------
Last Update Date | 10/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 WILLIAMS TRACE BLVD SUITE 200
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-4526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-404-3280
-----------------------------------------------------
Fax | 281-404-3281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 WILLIAMS TRACE BLVD SUITE 200
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-4526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-404-3280
-----------------------------------------------------
Fax | 281-404-3281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MARILYN K CHRISTIAN
-----------------------------------------------------
Credential | RN, BSN, CNOR, CASC
-----------------------------------------------------
Telephone | 281-404-3280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 130124
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------