Basic Information
| Provider Information | |||||||||
| NPI: | 1639653348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMVET SURGICAL AFFILIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2550 | ||||||||
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| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750302550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142272457 | ||||||||
| FaxNumber: | 2147640880 | ||||||||
| Practice Location | |||||||||
| Address1: | 22202 MEANDERING SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773891463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142272457 | ||||||||
| FaxNumber: | 2147640880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCCOWAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | CLARENCE | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED SURGICAL PA/ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8323530636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.