Provider Demographics
NPI:1952622219
Name:AVANTI SURGICAL PA
Entity Type:Organization
Organization Name:AVANTI SURGICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:DEBENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-622-5116
Mailing Address - Street 1:4151 SOUTHWEST FWY STE 715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9180 KATY FWY STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7443
Practice Address - Country:US
Practice Address - Phone:713-647-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical