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PROVINCIAL PARK SURGERY CENTER, LLC
NPI 1215204268
Clinic/Center - Ambulatory Surgical in Katy, TX

Active since November 18, 2011CLIA 45D2039129 · Waiver
21300 PROVINCIAL BLVD, SUITE 200, KATY, TX 77450(713) 554-7500(713) 554-6656 Get Directions Write a Review

NPPES record last updated: November 18, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Provincial Park Surgery Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVINCIAL PARK SURGERY CENTER, LLC (NPI 1215204268) is a healthcare organization registered as an ambulatory surgical in Katy, Texas and active in the NPI registry since November 2011. The organization holds a CLIA Waiver certificate valid through April 1, 2028 and lists Mennen T. Gallas, Chairman Of The Board, as its authorized official.

NPPES Registry Identity

NPI1215204268
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NamePROVINCIAL PARK SURGERY CENTER, LLC
Location Address21300 PROVINCIAL BLVD, SUITE 200Katy, TX 77450-7580
Mailing Address21300 Provincial Blvd, Suite 200Katy, TX 77450-7580 · (713) 554-7500 · Fax (713) 554-6656
Phone(713) 554-7500
Fax(713) 554-6656
Organization SubpartNo
Authorized OfficialMennen T. GallasChairman Of The Board · (281) 646-1114
Enumeration DateNovember 18, 2011
✔ NPI 1215204268 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
21300 PROVINCIAL BLVD, Katy, TX 77450
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2039129

Provincial Park Surgery Center · Katy, TX
Active · expires Apr 1, 2028
CLIA Number45D2039129
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateApril 2, 2026
Certificate Expiration DateApril 1, 2028
Laboratory DirectorMennen Gallas
Laboratory Phone(713) 554-6350
Laboratory LocationProvincial Park Surgery Center21300 Provincial Blvd Ste 200, Katy, TX 77450
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MENNEN T. GALLAS, MD PA
Plastic Surgery
21300 PROVINCIAL BLVD
KATY, TX 77450
Harris County (281) 646-1114
PROVENTIAL MEDICAL GROUP
Pain Medicine (Interventional Pain Medicine)
21300 PROVINCIAL BLVD, SUITE 200
KATY, TX 77450
Harris County (713) 562-7890

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provincial Park Surgery Center, LLC's NPI number?

The NPI number for Provincial Park Surgery Center, LLC is 1215204268. It was assigned to this organization in the NPPES registry on November 18, 2011.

Where is Provincial Park Surgery Center, LLC located?

Provincial Park Surgery Center, LLC is located at 21300 Provincial Blvd Suite 200, Katy, TX 77450. The listed phone number is (713) 554-7500.

What is Provincial Park Surgery Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Provincial Park Surgery Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2039129) is associated with this NPI, valid through April 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Provincial Park Surgery Center, LLC was last updated on November 18, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.