MEDICARE: WESTSIDE SURGICAL HOSPITAL, 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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1962866186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE SURGICAL HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	5120 WOODWAY DR STE 7012
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1791
Country	:	US
Telephone Number	:	713-532-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2256 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2008
Country	:	US
Telephone Number	:	713-532-7311
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	OMAR KIGGUNDU
Credential	:
Telephone Number	:	713-532-7311

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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