MEDICARE: MIDTOWN SURGICAL ASSOCIATES, P.A.

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	M0768	TX

General Provider Information

NPI Number	:	1215006788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN SURGICAL ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	11301 FALLBROOK DR
Second Line	:	#320
City	:	HOUSTON
State	:	TX
Zip	:	77065-4237
Country	:	US
Telephone Number	:	713-467-5787
Fax Number	:	713-468-4443

Provider Business Practice Location Address
First Line	:	9180 OLD KATY RD
Second Line	:	SUITE 202
City	:	HOUSTON
State	:	TX
Zip	:	77055-7454
Country	:	US
Telephone Number	:	713-647-7700
Fax Number	:	713-647-8090

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. GARFIELD JOHNSON III
Credential	:	M.D.
Telephone Number	:	713-467-5787

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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