MEDICARE: THREE LAKES SURGICARE PLLC

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	P1720	TX

General Provider Information

NPI Number	:	1366711632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE LAKES SURGICARE PLLC

Provider Business Mailing Address
First Line	:	5000 BEE CAVE RD STE 202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5254
Country	:	US
Telephone Number	:	512-328-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 BEE CAVE RD STE 202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5254
Country	:	US
Telephone Number	:	512-328-8900
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PODIATRIC MEDICINE
Name	:	DR. CRAIG H THOMAJAN
Credential	:	D.P.M.
Telephone Number	:	512-328-8900

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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