MEDICARE: OUTPATIENT SPECIAL SURGERY PARTNERS LTD

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	008095	TX

General Provider Information

NPI Number	:	1487738324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTPATIENT SPECIAL SURGERY PARTNERS LTD

Provider Business Mailing Address
First Line	:	9180 OLD KATY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7454
Country	:	US
Telephone Number	:	713-647-7700
Fax Number	:	713-647-7702

Provider Business Practice Location Address
First Line	:	9180 OLD KATY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7454
Country	:	US
Telephone Number	:	713-647-7700
Fax Number	:	713-647-7702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACK JENSEN
Credential	:	M.D.
Telephone Number	:	713-984-1400

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/02/2014

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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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1215006788 — MIDTOWN SURGICAL ASSOCIATES, P.A.
Practice Location Address:

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