Provider Demographics
NPI:1700836756
Name:SOUTHWEST BARIATRIC SURGEONS PLLC
Entity Type:Organization
Organization Name:SOUTHWEST BARIATRIC SURGEONS PLLC
Other - Org Name:SHERROD MARK R MEMBER C/O MARK R SHERROD
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-334-1890
Mailing Address - Street 1:3705 MEDICAL PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1027
Mailing Address - Country:US
Mailing Address - Phone:512-302-1210
Mailing Address - Fax:512-451-9752
Practice Address - Street 1:3705 MEDICAL PKWY STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1027
Practice Address - Country:US
Practice Address - Phone:512-302-1210
Practice Address - Fax:512-451-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00268XMedicare UPIN