MEDICARE: PIN OAK MEDICAL 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1518348002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIN OAK MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	1000 JORIE BLVD
Second Line	:	370
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2214
Country	:	US
Telephone Number	:	331-305-2813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 PIN OAK RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6849
Country	:	US
Telephone Number	:	331-305-2813
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARLA GUICE
Credential	:
Telephone Number	:	331-305-2813

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	12/07/2016

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