MEDICARE: BARIATRIC AND GENERAL SURGERY OF KINGWOOD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659038792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARIATRIC AND GENERAL SURGERY OF KINGWOOD, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 5479
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77325-5479
Country	:	US
Telephone Number	:	281-825-5100
Fax Number	:	281-825-5101

Provider Business Practice Location Address
First Line	:	855 ROCKMEAD DR STE 202
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2880
Country	:	US
Telephone Number	:	281-825-5100
Fax Number	:	281-825-5101

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	TRINA GARAY
Credential	:
Telephone Number	:	303-621-4826

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	04/09/2026

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