Provider Demographics
NPI:1568569838
Name:MASTER CENTER FOR LAPAROSCOPIC SURGERY-TEXAS,LLP
Entity Type:Organization
Organization Name:MASTER CENTER FOR LAPAROSCOPIC SURGERY-TEXAS,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-748-0200
Mailing Address - Street 1:1545 E SOUTHLAKE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6464
Mailing Address - Country:US
Mailing Address - Phone:817-748-0200
Mailing Address - Fax:817-749-0204
Practice Address - Street 1:1545 E SOUTHLAKE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6464
Practice Address - Country:US
Practice Address - Phone:817-748-0200
Practice Address - Fax:817-749-0204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASTER CENTER FOR MINIMALLY INVASIVE SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH23568Medicare UPIN
TXB26365Medicare UPIN