PROVINCIAL PARK SURGERY CENTER LLC NPI 1215204268

NPI Information

NPI: 1215204268
Provider Name: PROVINCIAL PARK SURGERY CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 45D2039129

Address:
21300 PROVINCIAL BLVD
SUITE 200
KATY, TX
ZIP 77450
Phone: (713) 554-7500
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PROVINCIAL PARK SURGERY CENTER, LLC is an ambulatory surgical clinic center in Katy, TX. PROVINCIAL PARK SURGERY CENTER, LLC NPI is 1215204268. The provider is registered as an organization entity type.

The provider's business location address is:

21300 PROVINCIAL BLVD
SUITE 200
KATY, TX
ZIP 77450-580
Phone: (713) 554-7500
Fax: (713) 554-6656

The provider's authorized official is Mennen T. Gallas .
The authorized official title is Chairman Of The Board and has the following contact phone number (281) 646-1114.

The CLIA number assigned to this NPI record is 45D2039129 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/18/2011 and was last updated on 11/18/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical		TEXAS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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