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General NPI Number Information
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NPI Number | 1598769481
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Entity Type | Organization
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Legal Business Name | MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 5146 PRESTON AVE
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City | PASADENA
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State | TX
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Zip | 77505-2054
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Country | US
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Telephone | 281-481-9303
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Fax | 281-481-4263
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Provider Business Mailing Address
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Address Line | 5146 PRESTON AVE
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City | PASADENA
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State | TX
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Zip | 77505-2054
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Country | US
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Telephone | 281-481-9303
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Fax | 281-481-4263
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Authorized Official
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Title or Position | OFFICER, AUTHORIZED OFFICIAL
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Name | NICHOLAS CRAFTS
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Credential |
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Telephone | 832-729-4009
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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 | 007115
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License Number State | TX
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