MEDICARE: ASP OF DICKINSON, LLP DBA UNIVERSITY GENERAL SURGICARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	008379	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134179153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASP OF DICKINSON, LLP DBA UNIVERSITY GENERAL SURGICARE

Provider Business Mailing Address
First Line	:	3750 MEDICAL PARK DRIVE
Second Line	:	#300
City	:	DICKINSON
State	:	TX
Zip	:	77539-6308
Country	:	US
Telephone Number	:	713-357-4400
Fax Number	:	713-559-6100

Provider Business Practice Location Address
First Line	:	3750 MEDICAL PARK DRIVE
Second Line	:	SUITE 300
City	:	DICKINSON
State	:	TX
Zip	:	77539-6308
Country	:	US
Telephone Number	:	713-357-4400
Fax Number	:	713-559-6100

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MRS. SHEKETHE TOSHA ROBERSON
Credential	:
Telephone Number	:	713-357-4400

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/23/2012

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