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NPI Code Detail

MEDICARE: PEGASUS SURGICAL SPECIALTY CENTER, P.A.

MEDICARE: PEGASUS SURGICAL SPECIALTY CENTER, 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
1284300000XSpecial Hospital

General Provider Information

NPI Number : 1306167283
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEGASUS SURGICAL SPECIALTY CENTER, P.A.
Provider Business Mailing Address
First Line : PO BOX 2041
Second Line :
City : STAFFORD
State : TX
Zip : 77497-2041
Country : US
Telephone Number : 713-774-7291
Fax Number : 713-774-5478
Provider Business Practice Location Address
First Line : 2807 LITTLE YORK RD
Second Line :
City : HOUSTON
State : TX
Zip : 77093-3405
Country : US
Telephone Number : 713-774-7291
Fax Number : 713-774-5478
Authorized Official
Title or Position : ACCOUNT MANAGER
Name : MR. THOMAS NGUYEN
Credential :
Telephone Number : 713-774-7291
Provider Enumeration Date : 06/15/2010
Last Update Date : 07/06/2010

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