MEDICARE: MVP SPECIALIST 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
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1457876898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVP SPECIALIST SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 735192
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-5192
Country	:	US
Telephone Number	:	713-244-5721
Fax Number	:	713-487-1523

Provider Business Practice Location Address
First Line	:	7501 FANNIN ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1953
Country	:	US
Telephone Number	:	713-244-5721
Fax Number	:	713-487-1523

Authorized Official
Title or Position	:	GOVERNING MEMBER
Name	:	MRS. JUANITTA FRANCIS
Credential	:
Telephone Number	:	713-244-5721

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	05/06/2020

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