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 yesterday at 1:29 PM.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