Provider Demographics
NPI:1700339744
Name:PREVITY SURGICAL CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:PREVITY SURGICAL CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:K
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 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-835-9500
Practice Address - Fax:409-835-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3987208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209346001Medicaid