MEDICARE: VISTA SURGICAL CENTER WEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	130046	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D0985134	OTHER		CLIA
2	HH1377	OTHER	TX	BCBS #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003839499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA SURGICAL CENTER WEST LLC

Provider Business Mailing Address
First Line	:	720 COOL SPRINGS BLVD
Second Line	:	SUITE 520
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2626
Country	:	US
Telephone Number	:	615-550-4913
Fax Number	:	615-550-4901

Provider Business Practice Location Address
First Line	:	2500 FONDREN RD
Second Line	:	SUITE 350
City	:	HOUSTON
State	:	TX
Zip	:	77063-2308
Country	:	US
Telephone Number	:	713-782-8279
Fax Number	:	713-782-3139

Authorized Official
Title or Position	:	COO
Name	:	MS. BRENDA H LEPLEY
Credential	:
Telephone Number	:	615-550-4913

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	05/20/2014

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