Southlake Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTHLAKE SURGERY CENTER, LLC

Practice address

521 W Southlake Blvd
Suite 175
Southlake, TX 76092-6173

Phone

(817) 328-2100

Fax

(817) 328-2103

NPI assigned

Nov 12, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jonathan Heistein, M.D.NPI 1972590404

Title

Medical Director

Phone

(817) 328-2100

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Barry Heistein, M.D.

  • Plastic Surgery Physician
  • Fort Worth, TX
  • NPI 1972590404
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1013218601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W SOUTHLAKE BLVD",
            "address_2": "SUITE 175",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926173",
            "telephone_number": "817-328-2100",
            "fax_number": "817-328-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W SOUTHLAKE BLVD",
            "address_2": "SUITE 175",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926173",
            "telephone_number": "817-328-2100",
            "fax_number": "817-328-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-12",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "HEISTEIN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "817-328-2100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southlake Psychological Associates, PLLC
• Southlake Serenity Psychiatry
• Southlake Sleep Center, LTD
• Southlake Specialty Hospital, LLC
• Southlake Sports & Spine Rehab PLLC
• Southlake Vision Group PLLC
• Southlake Weight Loss, LLC
• Southlake Wound Care & Hyperbarics
• Kimberly Michelle Sowell, MS PT
• David K Spady, M.D.

• All providers in Southlake, TX
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.