NPIMap

Organization Active NPI

Divine Surgical Services LLC

  • Surgical Physician Assistant
  • Stafford, TX
National Provider Identifier
1881350056
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
DIVINE SURGICAL SERVICES LLC
Practice address
110 Nina LN
Stafford, TX 77477-4647
Phone
(800) 801-9297
NPI assigned
Nov 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Zemorah Israel, LSANPI 1467750661
Title
Owner/ Ceo
Phone
(800) 801-9297

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X Primary

Addresses

Primary practice location

110 Nina LN
Stafford, TX 77477-4647

Mailing address

PO Box 97
Stafford, TX 77497-0097

National Provider Directory

National Provider Directory

Locations

4110 Bluebonnet Dr
Stafford, TX 77477

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1636675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1881350056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774970097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 NINA LN",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774774647",
            "telephone_number": "800-801-9297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE SURGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-12",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "ISRAEL",
        "authorized_official_first_name": "ZEMORAH",
        "authorized_official_title_or_position": "OWNER/ CEO",
        "authorized_official_telephone_number": "800-801-9297",
        "authorized_official_credential": "LSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.