MEDICARE: BOSTON MEDICAL GROUP - TEXAS, P.A.

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1922425230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON MEDICAL GROUP - TEXAS, P.A.

Provider Business Mailing Address
First Line	:	1776 YORKTOWN ST STE 110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4138
Country	:	US
Telephone Number	:	713-439-0229
Fax Number	:	713-439-0267

Provider Business Practice Location Address
First Line	:	1776 YORKTOWN ST STE 110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4138
Country	:	US
Telephone Number	:	713-439-0229
Fax Number	:	713-439-0267

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOAN SIMPSON
Credential	:
Telephone Number	:	615-562-4048

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	01/31/2020

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