Provider Demographics
NPI:1578500815
Name:ADVANCED LAPAROENDOSCOPIC SURGERY, PLLC
Entity Type:Organization
Organization Name:ADVANCED LAPAROENDOSCOPIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHU
Authorized Official - Middle Name:M
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-245-9183
Mailing Address - Street 1:3005 WEST LOOP S
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6100
Mailing Address - Country:US
Mailing Address - Phone:713-892-5478
Mailing Address - Fax:713-622-8346
Practice Address - Street 1:3005 WEST LOOP S
Practice Address - Street 2:SUITE 225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6100
Practice Address - Country:US
Practice Address - Phone:713-892-5478
Practice Address - Fax:713-622-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL22242086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TX=========OtherTAX ID
TX=========OtherTAX ID