MEDICARE: WORTHAM SURGERY GROUP

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	:	1093057713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORTHAM SURGERY GROUP

Provider Business Mailing Address
First Line	:	5318 WESLAYAN ST
Second Line	:	#183
City	:	HOUSTON
State	:	TX
Zip	:	77005-1048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13114 FM 1960 RD W
Second Line	:	#118
City	:	HOUSTON
State	:	TX
Zip	:	77065-4290
Country	:	US
Telephone Number	:	713-333-7982
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHOBHA AGGARWAL
Credential	:
Telephone Number	:	713-333-7982

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	04/19/2013

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