NPIMap

Organization Active NPI

Eastlake Surgical Associates, LLC

  • Surgical Physician Assistant
  • Conroe, TX
National Provider Identifier
1780163378
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
SA00639 Issued in TX
Legal business name
EASTLAKE SURGICAL ASSOCIATES, LLC
Practice address
2007 Shasta Ridge Dr
Conroe, TX 77304-4697
Phone
(936) 444-7071
NPI assigned
Aug 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Authorized official

Name
Tiffany Brooke Moreland, LSANPI 1811283310
Title
Licensed Surgical Assistant
Phone
(936) 444-7071

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X SA00639 TX Primary

Addresses

Primary practice location

2007 Shasta Ridge Dr
Conroe, TX 77304-4697

Mailing address

2007 Shasta Ridge Dr
Conroe, TX 77304-4697
Phone (936) 444-7071

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1780163378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 SHASTA RIDGE DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044697",
            "telephone_number": "936-444-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2007 SHASTA RIDGE DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044697",
            "telephone_number": "936-444-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAKE SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-14",
        "last_updated": "2022-03-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "MORELAND",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "BROOKE",
        "authorized_official_title_or_position": "LICENSED SURGICAL ASSISTANT",
        "authorized_official_telephone_number": "936-444-7071",
        "authorized_official_credential": "LSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "SA00639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; 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.