Pediatric Ambulatory Surgery Center Southlake

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PEDIATRIC AMBULATORY SURGERY CENTER SOUTHLAKE

Practice address

470 E State Highway 114
Southlake, TX 76092-4406

Phone

(817) 730-5437

Fax

(817) 724-0010

NPI assigned

Oct 6, 2015

Last updated

Nov 10, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jerry Lee

Title

Vice President of Accounting

Phone

(214) 456-0588

Specialties & licenses 1

Addresses

Other names 1

• Childrenshealth Surgery Center Other name

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447113600000",
    "number": "1235509993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 E STATE HIGHWAY 114",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924406",
            "telephone_number": "817-730-5437",
            "fax_number": "817-724-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 E STATE HIGHWAY 114",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924406",
            "telephone_number": "817-730-5437",
            "fax_number": "817-724-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AMBULATORY SURGERY CENTER SOUTHLAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "last_updated": "2015-11-10",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "VICE PRESIDENT OF ACCOUNTING",
        "authorized_official_telephone_number": "214-456-0588",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Childrenshealth Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Peak Physical Therapy, LLC
• Erica Jean Pearson, DC
• Amber Peck, P.T.
• Daniel Peckenpaugh, MD
• Pediaplex Management Company LLC
• Pediatric Speech Stars, PLLC
• Caitlin Elizabeth Pedigo, RNFA
• William Robert Peeler
• Shahab Sean Peikari, BCBA
• Pelvic Lab

• Ambulatory Surgical Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.