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General NPI Number Information
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NPI Number | 1619971504
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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 | 07/24/2019
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Provider Practice Location Address
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Address Line | 3534 VISTA RD
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City | PASADENA
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State | TX
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Zip | 77504-1728
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Country | US
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Telephone | 713-947-0330
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Fax | 713-947-6562
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Provider Business Mailing Address
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Address Line | 3534 VISTA RD
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City | PASADENA
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State | TX
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Zip | 77504-1728
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Country | US
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Telephone | 713-947-0330
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Fax | 713-947-6562
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Authorized Official
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Title or Position | OFFICER / AUTHORIZED OFFICIAL
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Name | JENETHA D MORAN
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Credential |
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Telephone | 972-763-3893
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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 | 007116
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License Number State | TX
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