MEDICARE: FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON 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	007215	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	ASC091	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20526	OTHER	TX	PHARMACY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	007215	OTHER	TX	FACILITY LICENSE
4	20117145	OTHER	TX	DPS
6	721500	OTHER		THCIC

General Provider Information

NPI Number	:	1811970494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION SURGERY AFFILIATES OF S.W. HOUSTON LLC

Provider Business Mailing Address
First Line	:	8111 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1705
Country	:	US
Telephone Number	:	713-272-6300
Fax Number	:	713-272-8532

Provider Business Practice Location Address
First Line	:	8111 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1705
Country	:	US
Telephone Number	:	713-272-6300
Fax Number	:	713-272-8532

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROBERT LERMA
Credential	:	MS,MBA,CASC
Telephone Number	:	713-272-6300

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/07/2023

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