Healthcare Provider Details

I. General information

NPI: 1508223041
Provider Name (Legal Business Name): BAYOU CITY SURGICAL SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 KIRBY DR SUITE 201
HOUSTON TX
77047-2580
US

IV. Provider business mailing address

412 QUITMAN ST
HOUSTON TX
77009-7753
US

V. Phone/Fax

Practice location:
  • Phone: 832-942-8350
  • Fax:
Mailing address:
  • Phone: 832-622-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TERAH ISAACSON
Title or Position: PARTNER
Credential: MD
Phone: 832-942-8350