MEDICARE: LAPAROSCOPY BARIATRICS & SURGERY PA

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	174400000X	Specialist	H7229	TX

General Provider Information

NPI Number	:	1568470227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAPAROSCOPY BARIATRICS & SURGERY PA

Provider Business Mailing Address
First Line	:	2501 PARKVIEW DR
Second Line	:	SUITE 560
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5824
Country	:	US
Telephone Number	:	817-850-1100
Fax Number	:	817-850-1104

Provider Business Practice Location Address
First Line	:	2501 PARKVIEW DR
Second Line	:	SUITE 560
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5824
Country	:	US
Telephone Number	:	817-850-1100
Fax Number	:	817-870-2553

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MYLA R PLENERT
Credential	:
Telephone Number	:	817-916-4699

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/17/2016

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