Provider Demographics
NPI:1437142932
Name:FOUNDATION SURGERY AFFILIATE OF WEST HOUSTON
Entity type:Organization
Organization Name:FOUNDATION SURGERY AFFILIATE OF WEST HOUSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-647-2300
Mailing Address - Street 1:15775 PARK TEN PL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5153
Mailing Address - Country:US
Mailing Address - Phone:281-647-2300
Mailing Address - Fax:281-550-7815
Practice Address - Street 1:15775 PARK TEN PL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5153
Practice Address - Country:US
Practice Address - Phone:281-647-2300
Practice Address - Fax:281-550-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008105261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085934001Medicaid
TX085934001Medicaid