Provider Demographics
NPI:1730146861
Name:CONROE SURGERY CENTER 2, LLC
Entity type:Organization
Organization Name:CONROE SURGERY CENTER 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-729-4009
Mailing Address - Street 1:1501 RIVER POINTE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2656
Mailing Address - Country:US
Mailing Address - Phone:936-760-3443
Mailing Address - Fax:936-760-1322
Practice Address - Street 1:1501 RIVER POINTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2656
Practice Address - Country:US
Practice Address - Phone:936-760-3443
Practice Address - Fax:936-760-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007984OtherLICENSE
45C0001018OtherCCN
TXASC135Medicare PIN