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General NPI Number Information
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NPI Number | 1568028827
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Entity Type | Organization
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Legal Business Name | NORTHWEST ENDOSURGICAL ASSOCIATES
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 21212 NORTHWEST FREEWAY SUITE #305
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City | CYPRESS
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State | TX
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Zip | 77429
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Country | US
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Telephone | 281-921-1890
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Fax | 281-921-1897
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Provider Business Mailing Address
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Address Line | 21212 NORTHWEST FREEWAY SUITE #305
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City | CYPRESS
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State | TX
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Zip | 77429
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Country | US
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Telephone | 281-921-1890
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Fax | 281-921-1897
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MATTHEW JAMES ST. LAURENT
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Credential | MD
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Telephone | 281-921-1890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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