Provider Demographics
NPI:1851804223
Name:M.I.T.E SURGICAL SERVICES
Entity Type:Organization
Organization Name:M.I.T.E SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-418-7216
Mailing Address - Street 1:16710 CHESTNUT SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4771
Mailing Address - Country:US
Mailing Address - Phone:832-418-7216
Mailing Address - Fax:
Practice Address - Street 1:16710 CHESTNUT SQUARE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4771
Practice Address - Country:US
Practice Address - Phone:832-418-7216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty