Organization
RENAISSANCE SURGICAL CENTER-NORTHEAST, L.L.P
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUSTAPHA KIBIRIGE M.D. (PRESIDENT)
(713) 532-7311
Entity
Organization
Contact information
Practice address
18929 HIGHWAY 59 N, HUMBLE, TX 77338-4270
(713) 532-7311
Mailing address
PO BOX 669, HUMBLE, TX 77347-0669
(713) 532-7311
(713) 532-7359
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
261QA1903X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1586968-01
—
TX
01
—
HH1370
BCBS GRP #
TX
Enumeration date
11/29/2006
Last updated
06/21/2018
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