Provider Demographics
NPI:1730266099
Name:MID TOWN SURGICAL CENTER LLP
Entity type:Organization
Organization Name:MID TOWN SURGICAL CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-691-6000
Mailing Address - Street 1:PO BOX 11810
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391
Mailing Address - Country:US
Mailing Address - Phone:713-691-6000
Mailing Address - Fax:713-691-1273
Practice Address - Street 1:2105 JACKSON ST
Practice Address - Street 2:STE #200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003
Practice Address - Country:US
Practice Address - Phone:713-691-6000
Practice Address - Fax:713-691-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXASC007972TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ04511537Medicaid
TX45C0001153Medicare ID - Type Unspecified