Provider Demographics
NPI:1568834455
Name:EXEMPLIFY SURGICAL FIRST ASSISTING
Entity Type:Organization
Organization Name:EXEMPLIFY SURGICAL FIRST ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CST
Authorized Official - Phone:214-546-2320
Mailing Address - Street 1:PO BOX 225466
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-5466
Mailing Address - Country:US
Mailing Address - Phone:214-546-2320
Mailing Address - Fax:214-518-6742
Practice Address - Street 1:3033 BARDIN RD
Practice Address - Street 2:1011
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3858
Practice Address - Country:US
Practice Address - Phone:214-546-2320
Practice Address - Fax:214-518-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital