Organization
KUMQUAT SURGICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY RANDALL TILLIS (DIRECTOR, BOM)
(713) 355-8600
Entity
Organization
Contact information
Practice address
4120 SOUTHWEST FWY, SUITE 200, HOUSTON, TX 77027-7339
(713) 355-8600
(713) 355-8069
Mailing address
PO BOX 4356, DEPT. 1707, HOUSTON, TX 77210-4356
(713) 355-8600
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
02/17/2009
Last updated
02/17/2009
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