MEDICARE: TEXAS LAPAROSCOPIC CONSULTANTS, 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	208600000X	Surgery Physician	L3813	TX
2	208600000X	Surgery Physician	M2217	TX
3	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74RD	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780857177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS LAPAROSCOPIC CONSULTANTS, LLP

Provider Business Mailing Address
First Line	:	5115 FANNIN ST.
Second Line	:	SUITE 950
City	:	HOUSTON
State	:	TX
Zip	:	77004-5898
Country	:	US
Telephone Number	:	713-493-7700
Fax Number	:	281-971-4065

Provider Business Practice Location Address
First Line	:	5115 FANNIN ST.
Second Line	:	SUITE 950
City	:	HOUSTON
State	:	TX
Zip	:	77004-5898
Country	:	US
Telephone Number	:	713-493-7700
Fax Number	:	281-971-4065

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	GINA CIOLLI
Credential	:
Telephone Number	:	713-493-7700

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/19/2022

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Directions to “TEXAS LAPAROSCOPIC CONSULTANTS, LLP ” Practice Location

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