Executive Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EXECUTIVE SURGERY CENTER, LLC

Practice address

13603 Michel Rd
Tomball, TX 77375-6410

Phone

(832) 698-3720

Fax

(832) 698-3721

NPI assigned

Jan 7, 2013

Last updated

Nov 4, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mohammed Tarek Al-Fahl, MD

Title

Owner/Physician

Phone

(832) 698-3720

Specialties & licenses 1

Addresses

Listed as

Executive Surgery CenterCCN 45C0001555

Medicare certification status

Terminated Voluntary: merger or closure, Mar 8, 2025From the Provider of Services file

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1114264488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13603 MICHEL RD SUITE 100",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "77375",
            "telephone_number": "832-698-3720",
            "fax_number": "832-698-3721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13603 MICHEL RD",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "773756410",
            "telephone_number": "832-698-3720",
            "fax_number": "832-698-3721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "AL-FAHL",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "TAREK",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "832-698-3720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.