Organization
DIVINE SURGICAL SERVICE LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MONIQUE BOWEN LSA (CEO)
(281) 414-7495
Entity
Organization
Contact information
Practice address
6140 HIGHWAY 6 STE 282, MISSOURI CITY, TX 77459-3802
(281) 414-7495
Mailing address
6140 HIGHWAY 6 STE 282, MISSOURI CITY, TX 77459-3802
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00461
TX
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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