MEDICARE: LAREDO SURGICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207T00000X	Neurological Surgery Physician
2	291U00000X	Clinical Medical Laboratory
3	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1710595996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAREDO SURGICAL CENTER

Provider Business Mailing Address
First Line	:	4606 PAYTON CHASE LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-3080
Country	:	US
Telephone Number	:	281-777-0878
Fax Number	:

Provider Business Practice Location Address
First Line	:	10410 MEDICAL LOOP BLDG 4A
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6672
Country	:	US
Telephone Number	:	281-777-0878
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DON VICKERS
Credential	:	M.ED.
Telephone Number	:	281-777-0878

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	04/28/2022

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Directions to “LAREDO SURGICAL CENTER ” Practice Location

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