Provider Demographics
NPI:1710152194
Name:EXQUISITE SURGERY ASSOC INC
Entity Type:Organization
Organization Name:EXQUISITE SURGERY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIMITROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-465-4106
Mailing Address - Street 1:306 CYPRESS VISTA
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094
Mailing Address - Country:US
Mailing Address - Phone:713-465-4106
Mailing Address - Fax:713-465-7334
Practice Address - Street 1:593 PINEY POINT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-465-4106
Practice Address - Fax:713-465-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty