MEDICARE: MEDICAL CENTER SURGICAL ASSISTANTS

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1285895094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER SURGICAL ASSISTANTS

Provider Business Mailing Address
First Line	:	PO BOX 20017
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77225-0017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4434 GALLAGHER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6218
Country	:	US
Telephone Number	:	713-806-4065
Fax Number	:	281-489-9839

Authorized Official
Title or Position	:	OFFICE MANAGER ASSISTANT
Name	:	MISS TANDY BANKS
Credential	:
Telephone Number	:	713-882-6889

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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