Organization
EAST WEST SURGERY CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLIN LEMAISTRE (OFFICER / AUTHORIZED OFFICIAL)
(214) 213-0732
Entity
Organization
Contact information
Practice address
2041 MESA VALLEY WAY, STE 125, AUSTELL, GA 30106-6828
(678) 309-8100
(678) 309-8101
Mailing address
2041 MESA VALLEY WAY, STE 125, AUSTELL, GA 30106-6828
(678) 309-8100
(678) 309-8101
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
033202
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00897047A
—
GA
01
—
166-510-500
DEPT OF LABOR
GA
01
—
2377093
AETNA H/POS
GA
01
—
327221
MEDICAID WELLCARE
GA
01
—
490005006
RR MEDICARE
GA
01
—
51795413002
BLUE CROSS
GA
01
—
68-00053
UNITED HEALTHCARE
GA
01
—
7467086
AETNA PPO
GA
Enumeration date
08/12/2005
Last updated
09/19/2024
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