Provider Demographics
NPI:1245709344
Name:MGH SURGICAL CARE PLLC
Entity type:Organization
Organization Name:MGH SURGICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIT
Authorized Official - Middle Name:NAVANIT
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-530-5043
Mailing Address - Street 1:PO BOX 21647
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1647
Mailing Address - Country:US
Mailing Address - Phone:813-866-1959
Mailing Address - Fax:813-530-5043
Practice Address - Street 1:10130 LOUETTA RD STE A-2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2118
Practice Address - Country:US
Practice Address - Phone:281-378-3355
Practice Address - Fax:281-378-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty