Provider Demographics
NPI:1063588804
Name:ADVANCED BARIATRIC SURGERY CENTER
Entity type:Organization
Organization Name:ADVANCED BARIATRIC SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-687-5670
Mailing Address - Street 1:3805 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1117
Mailing Address - Country:US
Mailing Address - Phone:806-687-5670
Mailing Address - Fax:806-687-5673
Practice Address - Street 1:3805 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-687-5670
Practice Address - Fax:806-687-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5583208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75136350Medicaid
TX159948201Medicaid
NM201041925Medicaid
NM201041925Medicaid
NM75136350Medicaid