MEDICARE: TRIAD SURGERY CENTER LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1245465582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAD SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	5433 WESTHEIMER RD
Second Line	:	SUITE 700
City	:	HOUSTON
State	:	TX
Zip	:	77056-5399
Country	:	US
Telephone Number	:	713-796-2200
Fax Number	:	713-840-7378

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST
Second Line	:	SUITE 2290
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	713-796-2200
Fax Number	:	713-840-7378

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. PAUL I COOK
Credential	:	M.D.
Telephone Number	:	713-796-2200

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	09/03/2009

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