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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