MEDICARE: TEXAS FOUNDATION SURGICAL

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1568620185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS FOUNDATION SURGICAL

Provider Business Mailing Address
First Line	:	PO BOX 25225
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77265-5225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4035
Country	:	US
Telephone Number	:	713-498-1529
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MOHSEN HOJABRI
Credential	:
Telephone Number	:	713-498-1529

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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1134095409 — CHRISTOPHER ANTHO DARREHSHOORI
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Directions to “TEXAS FOUNDATION SURGICAL ” Practice Location

Language	Start Address	Practice Location

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