Organization
PEDIATRIC AMBULATORY SURGERY CENTER SOUTHLAKE
Active
Other names
Childrenshealth Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY LEE (VICE PRESIDENT OF ACCOUNTING)
(214) 456-0588
Entity
Organization
Contact information
Practice address
470 E STATE HIGHWAY 114, SOUTHLAKE, TX 76092-4406
(817) 730-5437
(817) 724-0010
Mailing address
470 E STATE HIGHWAY 114, SOUTHLAKE, TX 76092-4406
(817) 730-5437
(817) 724-0010
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/06/2015
Last updated
11/10/2015
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