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General NPI Number Information
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NPI Number | 1801465273
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Entity Type | Organization
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Legal Business Name | EVERGREEN NEUROSURGERY CENTER, PLLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD STE 335
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City | CONROE
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State | TX
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Zip | 77304-2960
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Country | US
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Telephone | 281-719-9681
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Fax | 877-805-3509
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Provider Business Mailing Address
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Address Line | PO BOX 130070
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City | SPRING
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State | TX
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Zip | 77393-0070
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Country | US
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Telephone | 281-719-9681
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Fax | 877-805-3509
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYRIL T SEBASTIAN
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Credential | MD
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Telephone | 281-719-9681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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