Provider Demographics
NPI:1326108622
Name:ADVANCED SURGICAL WELLNESS
Entity Type:Organization
Organization Name:ADVANCED SURGICAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-620-2133
Mailing Address - Street 1:133 N FRIENDSWOOD DR # 303
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3746
Mailing Address - Country:US
Mailing Address - Phone:281-620-2133
Mailing Address - Fax:713-691-1273
Practice Address - Street 1:2105 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-5839
Practice Address - Country:US
Practice Address - Phone:281-620-2133
Practice Address - Fax:713-691-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7942261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122248127Medicaid
TX8B8314Medicare ID - Type Unspecified