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General NPI Number Information
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NPI Number | 1326038100
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Entity Type | Organization
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Legal Business Name | FOUNDATION SURGERY AFFILIATE OF THE MEDCENTER LLC
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 2459 S BRAESWOOD BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4305
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Country | US
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Telephone | 713-529-8600
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Fax | 713-529-8603
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Provider Business Mailing Address
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Address Line | 2459 S BRAESWOOD BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4305
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Country | US
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Telephone | 713-529-8600
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Fax | 713-529-8603
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MS. RUTH A MAXWELL
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Credential |
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Telephone | 713-529-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7897
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License Number State | TX
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