Provider Demographics
NPI:1972048510
Name:SURGICALIST OF TX PLLC
Entity Type:Organization
Organization Name:SURGICALIST OF TX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-530-5043
Mailing Address - Street 1:PO BOX 21647
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1647
Mailing Address - Country:US
Mailing Address - Phone:813-530-5043
Mailing Address - Fax:813-866-1957
Practice Address - Street 1:909 9TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3916
Practice Address - Country:US
Practice Address - Phone:972-665-6501
Practice Address - Fax:972-866-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty