Provider Demographics
NPI:1861846289
Name:SURGERY IN MOTION
Entity type:Organization
Organization Name:SURGERY IN MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:214-364-6769
Mailing Address - Street 1:PO BOX 2923
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-2923
Mailing Address - Country:US
Mailing Address - Phone:214-364-6769
Mailing Address - Fax:
Practice Address - Street 1:7512 FOREST BEND DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:TX
Practice Address - Zip Code:75002-6823
Practice Address - Country:US
Practice Address - Phone:214-364-6769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0801279431251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care