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NPI Code Detail

MEDICARE: ST MICHAELS CENTER FOR SPECIAL SURGERY LTD

MEDICARE: ST MICHAELS CENTER FOR SPECIAL SURGERY LTD
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
1261QA1903XAmbulatory Surgical Clinic/Center008261TX

General Provider Information

NPI Number : 1871617563
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST MICHAELS CENTER FOR SPECIAL SURGERY LTD
Provider Business Mailing Address
First Line : PO BOX 924369
Second Line :
City : HOUSTON
State : TX
Zip : 77292-4369
Country : US
Telephone Number : 713-812-1612
Fax Number :
Provider Business Practice Location Address
First Line : 3726 DACOMA ST
Second Line :
City : HOUSTON
State : TX
Zip : 77092-8906
Country : US
Telephone Number : 713-812-1612
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. RANDOLPH ALPHONSE LOPEZ
Credential : M.D.,
Telephone Number : 713-812-1612
Provider Enumeration Date : 03/19/2007
Last Update Date : 08/22/2020

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Directions to “ST MICHAELS CENTER FOR SPECIAL SURGERY LTD ” Practice Location

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