MEDICARE: MBC AMBULATORY SURGERY CENTER, LP

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	008536	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710082680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBC AMBULATORY SURGERY CENTER, LP

Provider Business Mailing Address
First Line	:	PO BOX 4346
Second Line	:	DEPT 368
City	:	HOUSTON
State	:	TX
Zip	:	77210-4346
Country	:	US
Telephone Number	:	713-275-2457
Fax Number	:	713-275-2466

Provider Business Practice Location Address
First Line	:	5115 FANNIN ST STE 1010
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5805
Country	:	US
Telephone Number	:	713-580-2500
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	JILL ROSALES
Credential	:
Telephone Number	:	713-275-2457

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/27/2025

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