MEDICARE: PELVIC SPECIALTY SURGERY SUITES 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	:	1265767180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELVIC SPECIALTY SURGERY SUITES LLC

Provider Business Mailing Address
First Line	:	PO BOX 268969
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 N CENTRAL EXPY
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75231-2220
Country	:	US
Telephone Number	:	214-360-1535
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN FEAGINS
Credential	:	MD
Telephone Number	:	214-360-1535

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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