Provider Demographics
NPI:1346646007
Name:DEL NORTE SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:DEL NORTE SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-683-4836
Mailing Address - Street 1:PO BOX 151782
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-5782
Mailing Address - Country:US
Mailing Address - Phone:817-683-4836
Mailing Address - Fax:
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:STE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3755
Practice Address - Country:US
Practice Address - Phone:817-683-4836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty