Provider Demographics
NPI:1356446512
Name:SURGICAL CRITICAL CARE ASSOCIATES, LLP
Entity Type:Organization
Organization Name:SURGICAL CRITICAL CARE ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVOUSPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-8501
Mailing Address - Street 1:PO BOX 12909
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2909
Mailing Address - Country:US
Mailing Address - Phone:409-899-8501
Mailing Address - Fax:409-899-8510
Practice Address - Street 1:2965 HARRISON ST
Practice Address - Street 2:SUITE 211
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1149
Practice Address - Country:US
Practice Address - Phone:409-899-8501
Practice Address - Fax:409-899-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208600000X
2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141564802Medicaid
TXCH4595OtherRR MEDICARE
TXCH4595OtherRR MEDICARE