MEDICARE: SOUTH TEXAS SURGERY MEDICAL CENTER 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	208VP0014X	Interventional Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0048JH	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1518156355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS SURGERY MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	5318 WESLAYAN ST # 175
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1048
Country	:	US
Telephone Number	:	866-511-9060
Fax Number	:	866-511-9060

Provider Business Practice Location Address
First Line	:	2646 S LOOP W STE 390
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5615
Country	:	US
Telephone Number	:	713-839-7555
Fax Number	:	281-201-4560

Authorized Official
Title or Position	:	AUTHORIZED OFFICER
Name	:	MRS. SHOBHA GUPTA
Credential	:
Telephone Number	:	866-511-9060

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	12/04/2008

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