1659038792 NPI number — BARIATRIC AND GENERAL SURGERY OF KINGWOOD, PLLC

Table of content: (NPI 1659038792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659038792 NPI number — BARIATRIC AND GENERAL SURGERY OF KINGWOOD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARIATRIC AND GENERAL SURGERY OF KINGWOOD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1659038792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5479
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77325-5479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-825-5100
Provider Business Mailing Address Fax Number:
281-825-5101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 KINGWOOD MEDICAL DR STE B100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77339-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-825-5100
Provider Business Practice Location Address Fax Number:
281-825-5101
Provider Enumeration Date:
11/23/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARAY
Authorized Official First Name:
TRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
303-621-4826

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)