MEDICARE: TEXAS COLORECTAL CLINIC PA

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	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1619282027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS COLORECTAL CLINIC PA

Provider Business Mailing Address
First Line	:	PO BOX 2245
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77252-2245
Country	:	US
Telephone Number	:	281-277-2121
Fax Number	:	281-277-2125

Provider Business Practice Location Address
First Line	:	16659 SOUTHWEST FWY
Second Line	:	SUITE 561
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2669
Country	:	US
Telephone Number	:	281-277-2121
Fax Number	:	281-277-2125

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SWARNA BALASUBRAMANIAM
Credential	:	MD
Telephone Number	:	281-277-2121

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/13/2010

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Directions to “TEXAS COLORECTAL CLINIC PA ” Practice Location

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