Basic Information
| Provider Information | |||||||||
| NPI: | 1497919708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING SURGICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25440 INTERSTATE 45 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773861343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816028160 | ||||||||
| FaxNumber: | 2814661052 | ||||||||
| Practice Location | |||||||||
| Address1: | 25440 I 45 NORTH | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816028160 | ||||||||
| FaxNumber: | 2814661052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | MOPARTY | ||||||||
| AuthorizedOfficialFirstName: | RAVI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2816028160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | L2481 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 2953127-01 | 05 | TX | MEDICAID |