Provider Demographics
NPI:1982088746
Name:BARIATRIC SERVICES GROUP, LLC
Entity type:Organization
Organization Name:BARIATRIC SERVICES GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-957-3825
Mailing Address - Street 1:1713 STATION PL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5014
Mailing Address - Country:US
Mailing Address - Phone:855-957-3825
Mailing Address - Fax:844-957-3825
Practice Address - Street 1:7274 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3492
Practice Address - Country:US
Practice Address - Phone:855-957-3825
Practice Address - Fax:844-957-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-11
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty