=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972417244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDOVASCULAR SPINE SURGERY INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18400 KATY FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77094-1286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-260-0500
-----------------------------------------------------
Fax | 832-260-0488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18400 KATY FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77094-1286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-260-0500
-----------------------------------------------------
Fax | 832-260-0488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARDIOVASCULAR SURGEON
-----------------------------------------------------
Name | DR. MIGUEL GOMEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-260-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------