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General NPI Number Information
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NPI Number | 1225127806
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Entity Type | Organization
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Legal Business Name | WILLOWBROOK SURGERY CENTER LTD
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13300 HARGRAVE #310
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City | HOUSTON
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State | TX
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Zip | 77070
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Country | US
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Telephone | 281-955-2175
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Fax | 281-955-8875
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Provider Business Mailing Address
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Address Line | 13300 HARGRAVE #310
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City | HOUSTON
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State | TX
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Zip | 77070
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Country | US
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Telephone | 281-955-2175
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Fax | 281-955-8875
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE
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Name | MRS. JANE TIPTON
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Credential |
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Telephone | 281-955-2175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 008301
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License Number State | TX
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