Southlake Surgery Center, LLC

NPI #1013218601 in Southlake, Texas

Provider Information

NPI Number
1013218601
Entity Type
Organization
Organization Name
Southlake Surgery Center, LLC
Primary Specialty
Clinic/Center - Ambulatory Surgical
Enumeration Date
Nov 12, 2010
Last Updated
Nov 12, 2010

Practice Location

Address
521 W SOUTHLAKE BLVD
Address 2
SUITE 175
State
Texas
ZIP Code
76092-6173
Phone
(817) 328-2100

Authorized Official

Name
DR. JONATHAN HEISTEIN, M.D.
Title
MEDICAL DIRECTOR
Phone
(817) 328-2100

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Ambulatory SurgicalAmbulatory Surgical

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