Provider Demographics
NPI:1568028827
Name:NORTHWEST ENDOSURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHWEST ENDOSURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ST. LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-921-1890
Mailing Address - Street 1:21212 NORTHWEST FREEWAY
Mailing Address - Street 2:SUITE #305
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:281-921-1890
Mailing Address - Fax:281-921-1897
Practice Address - Street 1:21212 NORTHWEST FREEWAY
Practice Address - Street 2:SUITE #305
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-921-1890
Practice Address - Fax:281-921-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty