Provider Demographics
NPI:1659517001
Name:BARIATRIC CARE CENTERS, PA
Entity Type:Organization
Organization Name:BARIATRIC CARE CENTERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:713-339-1353
Mailing Address - Street 1:PO BOX 56612
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77256-6612
Mailing Address - Country:US
Mailing Address - Phone:713-339-1353
Mailing Address - Fax:
Practice Address - Street 1:5757 WESTHEIMER RD
Practice Address - Street 2:SUITE # 104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5749
Practice Address - Country:US
Practice Address - Phone:713-339-1353
Practice Address - Fax:713-339-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8186208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482040Medicaid
I10771Medicare UPIN
VA00X479R02Medicare PIN