MEDICARE: ADVANCED SURGICAL WELLNESS

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	261QM2500X	Medical Specialty Clinic/Center	E7942	TX

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

General Provider Information

NPI Number	:	1326108622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SURGICAL WELLNESS

Provider Business Mailing Address
First Line	:	133 N FRIENDSWOOD DR # 303
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3746
Country	:	US
Telephone Number	:	281-620-2133
Fax Number	:	713-691-1273

Provider Business Practice Location Address
First Line	:	2105 JACKSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-5839
Country	:	US
Telephone Number	:	281-620-2133
Fax Number	:	713-691-1273

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM GARRETT
Credential	:	M.D.
Telephone Number	:	281-620-2133

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	06/16/2008

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Directions to “ADVANCED SURGICAL WELLNESS ” Practice Location

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