MEDICARE: ATLAS SURGICAL SOLUTIONS, INC

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

General Provider Information

NPI Number	:	1427293018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS SURGICAL SOLUTIONS, INC

Provider Business Mailing Address
First Line	:	5611 BELLAIRE BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5631
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 JACKSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-5839
Country	:	US
Telephone Number	:	713-691-6000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. IHSAN SHANTI
Credential	:
Telephone Number	:	713-339-1566

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	12/10/2008

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