NPIMap

Organization Active NPI

Memorial Hermann Surgery Center Preston Road, LTD.

  • Ambulatory Surgical Clinic/Center
  • Pasadena, TX
National Provider Identifier
1619971504
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
007116 Issued in TX
Legal business name
MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.
Practice address
3534 Vista Rd
Pasadena, TX 77504-1728
Phone
(713) 947-0330
Fax
(713) 947-6562
NPI assigned
Jun 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

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

Authorized official

Name
Jenetha D Moran
Title
Officer / Authorized Official
Phone
(972) 763-3893

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 007116 TX Primary

Addresses

Primary practice location

3534 Vista Rd
Pasadena, TX 77504-1728

Mailing address

3534 Vista Rd
Pasadena, TX 77504-1728
Phone (713) 947-0330

Other identifiers 2

IdentifierTypeStateIssuer
490004677OtherTXRAILROAD MEDICARE
10021532MedicaidTX

Other names 1

  • Doctors Outpatient Surgicenter Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091015000387 TX Part B Supplier - Ambulatory Surgical Center 0244376606 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pasadena, TX

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1619971504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3534 VISTA RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775041728",
            "telephone_number": "713-947-0330",
            "fax_number": "713-947-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3534 VISTA RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775041728",
            "telephone_number": "713-947-0330",
            "fax_number": "713-947-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JENETHA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "972-763-3893"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "007116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004677",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10021532",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Outpatient Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Doctors Outpatient Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.