MEDICARE: FOUNDATION SURGERY AFFILIATE OF THE MEDCENTER 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	7897	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326038100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION SURGERY AFFILIATE OF THE MEDCENTER LLC

Provider Business Mailing Address
First Line	:	2459 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4305
Country	:	US
Telephone Number	:	713-529-8600
Fax Number	:	713-529-8603

Provider Business Practice Location Address
First Line	:	2459 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4305
Country	:	US
Telephone Number	:	713-529-8600
Fax Number	:	713-529-8603

Authorized Official
Title or Position	:	ADMINISTRATOR/CEO
Name	:	MS. RUTH A MAXWELL
Credential	:
Telephone Number	:	713-529-8600

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	06/17/2009

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