Provider Demographics
NPI:1851522114
Name:LONE STAR SURGICARE
Entity Type:Organization
Organization Name:LONE STAR SURGICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKWANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-225-4013
Mailing Address - Street 1:PO BOX 14244
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-4244
Mailing Address - Country:US
Mailing Address - Phone:281-225-4013
Mailing Address - Fax:
Practice Address - Street 1:13010 RYAN EAGLES DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-5077
Practice Address - Country:US
Practice Address - Phone:281-225-4013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLSA0181171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLSA0181OtherLICENSED SURGICAL ASSIST