Provider Demographics
NPI:1174032239
Name:SURGICAL WELLNESS HOLDINGS LLC
Entity Type:Organization
Organization Name:SURGICAL WELLNESS HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:VIKTOR
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-814-1558
Mailing Address - Street 1:2516 PROVINE RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3938
Mailing Address - Country:US
Mailing Address - Phone:903-814-1558
Mailing Address - Fax:
Practice Address - Street 1:2516 PROVINE RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3938
Practice Address - Country:US
Practice Address - Phone:903-814-1558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1605207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty