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General NPI Number Information
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NPI Number | 1952675290
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Entity Type | Organization
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Legal Business Name | NASA SURGICAL SUITE, LLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 250 BLOSSOM ST SUITE 120B
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City | WEBSTER
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State | TX
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Zip | 77598-4204
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Country | US
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Telephone | 281-404-3164
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Fax |
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Provider Business Mailing Address
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Address Line | 250 BLOSSOM ST SUITE 120B
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City | WEBSTER
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State | TX
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Zip | 77598-4204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAMES DIETER
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Credential |
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Telephone | 281-404-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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