Organization
SOUTHLAKE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN HEISTEIN M.D. (MEDICAL DIRECTOR)
(817) 328-2100
Entity
Organization
Contact information
Practice address
521 W SOUTHLAKE BLVD, SUITE 175, SOUTHLAKE, TX 76092-6173
(817) 328-2100
(817) 328-2103
Mailing address
521 W SOUTHLAKE BLVD, SUITE 175, SOUTHLAKE, TX 76092-6173
(817) 328-2100
(817) 328-2103
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/12/2010
Last updated
11/12/2010
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