MEDICARE: DREWERYS, 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

General Provider Information

NPI Number	:	1083869580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREWERYS, LLC

Provider Business Mailing Address
First Line	:	4265 SAN FELIPE ST
Second Line	:	SUITE 1100
City	:	HOUSTON
State	:	TX
Zip	:	77027-2920
Country	:	US
Telephone Number	:	713-960-6692
Fax Number	:	713-960-6691

Provider Business Practice Location Address
First Line	:	1505 LIBERTY ST
Second Line	:	SUITE 200
City	:	RICHMOND
State	:	TX
Zip	:	77469-3218
Country	:	US
Telephone Number	:	713-960-6692
Fax Number	:	713-960-6691

Authorized Official
Title or Position	:	MANAGER
Name	:	KRAIG KILLOUGH
Credential	:
Telephone Number	:	713-960-6697

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	11/25/2008

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Directions to “DREWERYS, LLC ” Practice Location

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