MEDICARE: PEARLAND SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center	130117	TX

General Provider Information

NPI Number	:	1184922353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLAND SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	15015 KIRBY DR
Second Line	:	STE. 100
City	:	HOUSTON
State	:	TX
Zip	:	77047-2573
Country	:	US
Telephone Number	:	832-255-7500
Fax Number	:	832-255-7501

Provider Business Practice Location Address
First Line	:	15015 KIRBY DR
Second Line	:	STE. 100
City	:	HOUSTON
State	:	TX
Zip	:	77047-2573
Country	:	US
Telephone Number	:	832-255-7500
Fax Number	:	832-255-7501

Authorized Official
Title or Position	:	MARKET PRESIDENT
Name	:	NICHOLAS CRAFTS
Credential	:
Telephone Number	:	832-729-4009

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	10/15/2024

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