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General NPI Number Information
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NPI Number | 1669721346
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Entity Type | Organization
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Legal Business Name | SUGAR LAND SURGICENTER
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 1229 CREEK WAY DR
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City | SUGAR LAND
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State | TX
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Zip | 77478-4555
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Country | US
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Telephone | 281-201-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 CREEK WAY DR STE 104
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City | SUGAR LAND
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State | TX
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Zip | 77478-4555
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Country | US
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Telephone | 281-201-8612
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MRS. BRENDA CASEY
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Credential |
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Telephone | 281-201-8612
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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 | 130123
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License Number State | TX
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