Provider Demographics
NPI:1134333685
Name:NEUROSURGERY PA
Entity type:Organization
Organization Name:NEUROSURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-870-9292
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 324
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-870-9292
Mailing Address - Fax:281-870-8493
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 324
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-870-9292
Practice Address - Fax:281-870-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0134207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1834830Medicaid
TX1834830Medicaid
F53195Medicare UPIN
TX5507170001Medicare NSC