Provider Demographics
NPI:1821471780
Name:PREVITY SURGICAL CLEAR LAKE, PLLC
Entity Type:Organization
Organization Name:PREVITY SURGICAL CLEAR LAKE, PLLC
Other - Org Name:PREVITY CLINIC FOR SURGICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-835-9500
Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4664
Mailing Address - Country:US
Mailing Address - Phone:409-835-9500
Mailing Address - Fax:409-835-0098
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:SUITE 285
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-487-3313
Practice Address - Fax:281-487-3316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVITY SURGICAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty