MEDICARE: COHEN AVE 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	PENDING	TX

General Provider Information

NPI Number	:	1205026069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHEN AVE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	4659 COHEN AVE.
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79924-4415
Country	:	US
Telephone Number	:	915-751-0000
Fax Number	:	915-751-0464

Provider Business Practice Location Address
First Line	:	4659 COHEN AVE.
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79924-4415
Country	:	US
Telephone Number	:	915-751-0000
Fax Number	:	915-751-0464

Authorized Official
Title or Position	:	MEMBER
Name	:	LLOYD DAVID WILLIAMS
Credential	:	DPM
Telephone Number	:	915-751-0000

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	02/27/2009

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