Basic Information
| Provider Information | |||||||||
| NPI: | 1952331092 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17510 W GRAND PKWY S | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812381600 | ||||||||
| FaxNumber: | 2812381650 | ||||||||
| Practice Location | |||||||||
| Address1: | 17510 W GRAND PKWY S | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812381600 | ||||||||
| FaxNumber: | 2812381650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | BLACH | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7133430832 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 8395 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 170389401 | 05 | TX | MEDICAID | 7100440572 | 01 | TX | RAILROAD MEDICARE | OTHER |