MEDICARE: DA VINCI SURGERY CENTER LLC

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

General Provider Information

NPI Number	:	1952740797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DA VINCI SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	5116 BISSONNET ST
Second Line	:	#315
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4007
Country	:	US
Telephone Number	:	713-333-7982
Fax Number	:	713-588-8618

Provider Business Practice Location Address
First Line	:	24727 TOMBALL PKWY
Second Line	:	#100
City	:	TOMBALL
State	:	TX
Zip	:	77375-7877
Country	:	US
Telephone Number	:	281-255-3902
Fax Number	:	713-391-8340

Authorized Official
Title or Position	:	MANAGER
Name	:	SHALINI AGGARWAL
Credential	:
Telephone Number	:	281-255-3902

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	07/25/2013

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