Provincial Park Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PROVINCIAL PARK SURGERY CENTER, LLC

Practice address

21300 Provincial Blvd
Suite 200
Katy, TX 77450-7580

Phone

(713) 554-7500

Fax

(713) 554-6656

NPI assigned

Nov 18, 2011

Last updated

Nov 18, 2011By 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

Mennen T. Gallas, MDNPI 1487667184

Title

Chairman of the Board

Phone

(281) 646-1114

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mennen T Gallas, MD

  • Plastic Surgery Physician
  • Katy, TX
  • NPI 1487667184
  Authorized official Same address or phone

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

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1215204268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21300 PROVINCIAL BLVD",
            "address_2": "SUITE 200",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774507580",
            "telephone_number": "713-554-7500",
            "fax_number": "713-554-6656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 PROVINCIAL BLVD",
            "address_2": "SUITE 200",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774507580",
            "telephone_number": "713-554-7500",
            "fax_number": "713-554-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVINCIAL PARK SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "GALLAS",
        "authorized_official_first_name": "MENNEN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "281-646-1114",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Prosperi, LCSW
• Prosperity Counseling Services
• Provential Medical Group
• Providence Health Care and Assisted Living
• Provincial Acupuncture & Wellness
• Elise Provost
• Kathy Provost
• PSMD PLLC
• Psych Health and Wellness PLLC
• Regan Lee Puckett, MD

• Ambulatory Surgical Clinic/Center in Katy, TX
• Providers in Katy, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.