Provider Demographics
NPI:1356362362
Name:BARIATRIC SPECIALISTS OF TEXAS
Entity type:Organization
Organization Name:BARIATRIC SPECIALISTS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-429-8155
Mailing Address - Street 1:801 S HIGHWAY 78
Mailing Address - Street 2:STE. 300
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5502
Mailing Address - Country:US
Mailing Address - Phone:972-429-8150
Mailing Address - Fax:972-429-8151
Practice Address - Street 1:801 S HIGHWAY 78
Practice Address - Street 2:STE. 300
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5502
Practice Address - Country:US
Practice Address - Phone:972-429-8150
Practice Address - Fax:972-429-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER