Provider Demographics
NPI:1821699976
Name:MEDISWAN LLC
Entity Type:Organization
Organization Name:MEDISWAN LLC
Other - Org Name:DR. G MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:481-381-8772
Mailing Address - Street 1:31 RED MOON PL
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4867
Mailing Address - Country:US
Mailing Address - Phone:480-381-8772
Mailing Address - Fax:832-271-7670
Practice Address - Street 1:1900 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2105
Practice Address - Country:US
Practice Address - Phone:832-271-7664
Practice Address - Fax:832-271-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty