MEDICARE: HOUSTON UROLOGIC SURGICENTER, 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	130092	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130092	OTHER	TX	TEXAS FACILITY LICENSE

General Provider Information

NPI Number	:	1568906212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON UROLOGIC SURGICENTER, LLC

Provider Business Mailing Address
First Line	:	4219 RICHMOND AVE
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77027-6893
Country	:	US
Telephone Number	:	713-634-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4219 RICHMOND AVE
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77027-6893
Country	:	US
Telephone Number	:	713-634-4433
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM GREGORY SWINNEY
Credential	:
Telephone Number	:	972-789-2877

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	04/18/2018

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