MEDICARE: MID TOWN SURGICAL CENTER LLP

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	ASC007972TX	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	:	1730266099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID TOWN SURGICAL CENTER LLP

Provider Business Mailing Address
First Line	:	PO BOX 11810
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77391
Country	:	US
Telephone Number	:	713-691-6000
Fax Number	:	713-691-1273

Provider Business Practice Location Address
First Line	:	2105 JACKSON ST
Second Line	:	STE #200
City	:	HOUSTON
State	:	TX
Zip	:	77003
Country	:	US
Telephone Number	:	713-691-6000
Fax Number	:	713-691-1273

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ALICE MARIE CRAVENS
Credential	:
Telephone Number	:	713-691-6000

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/16/2007

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