Provider Demographics
NPI:1407692817
Name:SYNOVA HEALTH
Entity type:Organization
Organization Name:SYNOVA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:512-492-5755
Mailing Address - Street 1:5656 BEE CAVES RD STE F201
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5236
Mailing Address - Country:US
Mailing Address - Phone:512-492-5755
Mailing Address - Fax:512-727-3982
Practice Address - Street 1:5656 BEE CAVES RD STE F201
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5236
Practice Address - Country:US
Practice Address - Phone:512-492-5755
Practice Address - Fax:512-727-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty