Provider Demographics
NPI:1518156355
Name:SOUTH TEXAS SURGERY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTH TEXAS SURGERY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHOBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-511-9060
Mailing Address - Street 1:5318 WESLAYAN ST # 175
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1048
Mailing Address - Country:US
Mailing Address - Phone:866-511-9060
Mailing Address - Fax:866-511-9060
Practice Address - Street 1:2646 S LOOP W STE 390
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5615
Practice Address - Country:US
Practice Address - Phone:713-839-7555
Practice Address - Fax:281-201-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048JHOtherBC/BS