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General NPI Number Information
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NPI Number | 1861681009
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Entity Type | Organization
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Legal Business Name | WELLSPRING CARDIOVASCULAR & THORACIC SURGERY, PA
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 6400 FANNIN ST STE. 2500
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City | HOUSTON
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State | TX
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Zip | 77030-1521
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Country | US
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Telephone | 713-795-4545
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Fax | 713-795-4595
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Provider Business Mailing Address
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Address Line | PO BOX 20056
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City | HOUSTON
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State | TX
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Zip | 77225-0056
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Country | US
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Telephone | 713-795-4545
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Fax | 713-795-4595
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Authorized Official
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Title or Position | OWNER
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Name | DR. CORNELIUS ALEXANDER DAVIS III
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Credential | M.D.
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Telephone | 713-795-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | L7349
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License Number State | TX
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