OrganizationWellspring Cardiovascular & Thoracic Surgery, PaThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansPractice Address6400 Fannin St, Ste. 2500, Houston, TX 77030-1521(713) 795-4545PECOS EnrollmentBased on the most recent information from CMS, provider Wellspring Cardiovascular & Thoracic Surgery, Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1861681009Provider TypeOrganizationFull NameWellspring Cardiovascular & Thoracic Surgery, PaSubpartNoEnumeration Date10/23/2007Last Updated10/24/2011Contact InformationPractice LocationPractice Address6400 Fannin St, Ste. 2500, Houston, TX 77030-1521Phone(713) 795-4545Fax(713) 795-4595Mailing LocationMailing AddressPO Box 20056, Houston, TX 77225-0056Phone(713) 795-4545Fax(713) 795-4595Authorized OfficialNameDavis, Cornelius Alexander (Owner)Phone(713) 795-4545Provider TaxonomiesCodeDescriptionLicenseCode208G00000XPrimaryDescriptionThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansLicenseL7349TexasProvider IdentifiersIDDescriptionIssuerID1528037975DescriptionOtherIssuerINDIVIDUAL NPITexasID1653768-01DescriptionMedicaidIssuerUnlistedTexas