Provider Demographics
NPI:1760705628
Name:MEDPRO SURGICARE
Entity Type:Organization
Organization Name:MEDPRO SURGICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-463-6309
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:DEPT 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1144
Mailing Address - Country:US
Mailing Address - Phone:281-463-6309
Mailing Address - Fax:281-463-6835
Practice Address - Street 1:921 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:281-463-6309
Practice Address - Fax:281-463-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty