Divine Surgical Service LLC.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

SA00461 Issued in TX

Legal business name

DIVINE SURGICAL SERVICE LLC.

Practice address

6140 Highway 6 Ste 282
Missouri City, TX 77459-3802

Phone

(281) 414-7495

NPI assigned

Sep 19, 2014

Last updated

Sep 19, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Monique Bowen, LSA

Title

Ceo

Phone

(281) 414-7495

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1407258528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 HIGHWAY 6 STE 282",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774593802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 HIGHWAY 6 STE 282",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774593802",
            "telephone_number": "281-414-7495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE SURGICAL SERVICE LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-19",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "281-414-7495",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "SA00461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Missouri City, TX
• Providers in Missouri City, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.