MEDICARE: HOUSTON PLASTIC AND CRANIOFACIAL SURGERY CENTER

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

General Provider Information

NPI Number	:	1316100621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON PLASTIC AND CRANIOFACIAL SURGERY CENTER

Provider Business Mailing Address
First Line	:	6400 FANNIN ST STE 2290
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	713-791-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 2290
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	713-791-0700
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	SEAN BOUTROS
Credential	:
Telephone Number	:	713-791-0700

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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