Provider Demographics
NPI:1053563833
Name:COLOPROCTOLOGY SURGICARE, INC.
Entity type:Organization
Organization Name:COLOPROCTOLOGY SURGICARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-474-7171
Mailing Address - Street 1:2110 SEABROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1626
Mailing Address - Country:US
Mailing Address - Phone:281-474-7171
Mailing Address - Fax:281-474-7177
Practice Address - Street 1:2110 SEABROOK CIR
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-1626
Practice Address - Country:US
Practice Address - Phone:281-474-7171
Practice Address - Fax:281-474-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-12
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043203128OtherPHYSICIAN NPI#
00B62HMedicare PIN
TXB20935 TXMedicare UPIN