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Organization
PROVINCIAL PARK SURGERY CENTER, LLC
Active
Organization
PROVINCIAL PARK SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MENNEN T. GALLAS MD (CHAIRMAN OF THE BOARD)
(281) 646-1114
Entity
Organization
Contact information
Practice address
21300 PROVINCIAL BLVD, SUITE 200, KATY, TX 77450-7580
(713) 554-7500
(713) 554-6656
Mailing address
21300 PROVINCIAL BLVD, SUITE 200, KATY, TX 77450-7580
(713) 554-7500
(713) 554-6656
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
TX
Other
Enumeration date
11/18/2011
Last updated
11/18/2011
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