=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619849882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH SHEPHERD AMBULATORY SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2025
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7272 N SHEPHERD DR BLDG B STE 101
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77091-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-692-0270
-----------------------------------------------------
Fax | 713-692-0210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7272 N SHEPHERD DR BLDG B STE 101
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77091-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-692-0270
-----------------------------------------------------
Fax | 713-692-0210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PROVIDER GROUP OPERATIONS
-----------------------------------------------------
Name | LAUREN ELLENBURG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-421-8745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------