MEDICARE: THIRD COAST PHYSICIAN SERVICES

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1790800167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THIRD COAST PHYSICIAN SERVICES

Provider Business Mailing Address
First Line	:	3030 S GESSNER RD
Second Line	:	#150
City	:	HOUSTON
State	:	TX
Zip	:	77063-3765
Country	:	US
Telephone Number	:	713-587-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 S GESSNER RD
Second Line	:	#150
City	:	HOUSTON
State	:	TX
Zip	:	77063-3765
Country	:	US
Telephone Number	:	713-587-0909
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	NANCY LE
Credential	:
Telephone Number	:	713-587-0909

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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Directions to “THIRD COAST PHYSICIAN SERVICES ” Practice Location

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