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General NPI Number Information
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NPI Number | 1912861295
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Entity Type | Organization
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Legal Business Name | AVICENNA HOSPITAL - SPRING
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 20635 KUYKENDAHL RD
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City | SPRING
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State | TX
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Zip | 77379-3533
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Country | US
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Telephone | 281-317-1118
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 HIGHWAY 13 E STE 255
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City | BURNSVILLE
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State | MN
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Zip | 55337-6865
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Country | US
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Telephone | 281-317-1118
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROSS MATLACK III
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Credential | FACHE
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Telephone | 419-577-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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