MEDICARE: TOWN AND COUNTRY SURGERY CENTER 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	:	1134946841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN AND COUNTRY SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	950 THREADNEEDLE ST STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2910
Country	:	US
Telephone Number	:	281-849-7555
Fax Number	:	281-849-7020

Provider Business Practice Location Address
First Line	:	950 THREADNEEDLE ST STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2910
Country	:	US
Telephone Number	:	281-849-7555
Fax Number	:	281-849-7020

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRAD KOVNAT
Credential	:
Telephone Number	:	713-294-6347

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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