1568569838 NPI number — MASTER CENTER FOR LAPAROSCOPIC SURGERY-TEXAS,LLP

Table of content: MR. CHARLES WHIPPO ROYSTON III MS (NPI 1528583960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568569838 NPI number — MASTER CENTER FOR LAPAROSCOPIC SURGERY-TEXAS,LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASTER CENTER FOR LAPAROSCOPIC SURGERY-TEXAS,LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568569838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 E SOUTHLAKE BLVD STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-748-0200
Provider Business Mailing Address Fax Number:
817-749-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 E SOUTHLAKE BLVD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-6464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-748-0200
Provider Business Practice Location Address Fax Number:
817-749-0204
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-748-0200

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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