MEDICARE: NORTH SHEPHERD AMBULATORY 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1619849882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHEPHERD AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	7272 N SHEPHERD DR BLDG B
Second Line	:	STE 101
City	:	HOUSTON
State	:	TX
Zip	:	77091-2435
Country	:	US
Telephone Number	:	713-692-0270
Fax Number	:	713-692-0210

Provider Business Practice Location Address
First Line	:	7272 N SHEPHERD DR BLDG B
Second Line	:	STE 101
City	:	HOUSTON
State	:	TX
Zip	:	77091-2435
Country	:	US
Telephone Number	:	713-692-0270
Fax Number	:	713-692-0210

Authorized Official
Title or Position	:	CHIEF PROVIDER GROUP OPERATIONS
Name	:	LAUREN ELLENBURG
Credential	:
Telephone Number	:	480-421-8745

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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