MEDICARE: GRAND PARKWAY SURGICAL INSTITUTE 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1699311936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND PARKWAY SURGICAL INSTITUTE LLC

Provider Business Mailing Address
First Line	:	7830 W GRAND PKWY S STE 150
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5819
Country	:	US
Telephone Number	:	281-456-4188
Fax Number	:	833-692-0041

Provider Business Practice Location Address
First Line	:	7830 W GRAND PKWY S STE 150
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5819
Country	:	US
Telephone Number	:	281-456-4188
Fax Number	:	833-692-0041

Authorized Official
Title or Position	:	CEO
Name	:	MS. DAYNA L RAMIREZ
Credential	:	N/A
Telephone Number	:	713-877-0600

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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