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NPI Code Detail

MEDICARE: MAGNA SURGERY CENTER, LLC

MEDICARE: MAGNA SURGERY CENTER, 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1326451527
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNA SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 3726 DACOMA ST
Second Line : SUITE 100
City : HOUSTON
State : TX
Zip : 77092-8906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3726 DACOMA ST
Second Line : SUITE 100
City : HOUSTON
State : TX
Zip : 77092-8906
Country : US
Telephone Number : 713-686-2462
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. DIPTI BAVISHI
Credential : M.D.
Telephone Number : 713-686-2462
Provider Enumeration Date : 06/05/2014
Last Update Date : 07/23/2015

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Directions to “MAGNA SURGERY CENTER, LLC ” Practice Location

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