Provider Demographics
NPI:1710413554
Name:DITTO SURGICAL, PLLC
Entity Type:Organization
Organization Name:DITTO SURGICAL, PLLC
Other - Org Name:ATX ROBOTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:DITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-436-8295
Mailing Address - Street 1:11615 ANGUS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4064
Mailing Address - Country:US
Mailing Address - Phone:512-436-9986
Mailing Address - Fax:512-436-8295
Practice Address - Street 1:11615 ANGUS RD STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4064
Practice Address - Country:US
Practice Address - Phone:512-436-9986
Practice Address - Fax:512-436-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX393645201Medicaid