Organization Name: | EXECUTIVE SURGERY CENTER, LLC |
NPI Number: | 1114264488 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MOHAMMED TAREK AL-FAHL (OWNER/PHYSICIAN) |
Mailing Address: | 13603 Michel Rd Tomball |
State: | TX US |
Postal Code: | 773756410 |
Phone Number: | 8326983720 |
Fax Number: | 8326983721 |
NPI Enumeration Date: | 01/07/2013 |
NPI Last Update Date: | 12/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |