SOUTH SHORE SURGICENTER LLC (NPI# 1336272665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336272665 |
| Entity Type | Organization |
| Organization Name | SOUTH SHORE SURGICENTER LLC |
| Practice Address |
2622 Marina Bay Drive League City TX 77573-6506 |
| Practice Telephone | 2815386600 |
| Practice Fax Number | 2815352800 |
| Mailing Telephone | 2815386600 |
| Mailing Fax Number | 2815352800 |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-01-02 |
| Authorized Official Name | CHARLES POLSEN (PROPRIETOR) |
| Authorized Official Telephone | 2815386600 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
130038 | TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BLUE CROSS/BLUE SHIELD OF TEXAS PROVIDER ID | OOO2CU | 01 |
| Street Address |
2622 MARINA BAY DRIVE |
| City | LEAGUE CITY |
| State | TX |
| Zip Code | 77573-6506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801929195 | Charles Polsen | Surgery | 2622 Marina Bay Drive, League City, TX 77573-6506 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114527306 | Colin Joe Lee | Pharmacist | 1088 W Main St League City, Tx 77573 United States, League City, TX 77573 | 2020-10-28 |
| 1033764931 | Brittany Salinas | Physical Medicine & Rehabilitation | 2205 Colonial Court N, League City, TX 77573 | 2019-08-07 |
| 1366007833 | Tmh Physician Associates Pllc | Orthopaedic Surgery | 2220 E. League City Parkway, Suite 200, League City, TX 77573 | 2019-05-09 |
| 1851863724 | Gina Carter | Durable Medical Equipment & Medical Supplies | 210 S. Hwy 3, Unit B, League City, TX 77573 | 2018-12-17 |
| 1497226393 | Daniel Max & Marcandrea LLC | Optometrist | 3170 Gulf Freeway South, League City, TX 77573 | 2018-12-17 |
| 1972071983 | Chelsie N Chonoski | Nurse Practitioner | 2240 Gulf Freeway South, Suite 2.110, League City, TX 77573 | 2018-11-07 |
| 1730660564 | Rebecca Ann Peth | Physical Therapist | 350 N Wesley Dr., Apt 1123, League City, TX 77573 | 2018-08-29 |
| 1912485087 | Sarwat Hussain Zaffer | Dentist | 1620 W Fm 646, Ste D, League City, TX 77573 | 2018-08-01 |
| 1518468651 | Clear Creek Chiropractic Center | Clinic/Center | 624 West Main Ste 102, League City, TX 77573 | 2018-02-23 |
| 1255850848 | Travis William Prothro | Chiropractor | 1620 W. Fm 646, Suite C, League City, TX 77573 | 2017-09-14 |
| Find all providers in zip 77573 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841409281 | So, Tx. Aesthetic Enhancement Center | Clinic/Center | 2525 S Shore Blvd Ste 201, League City, TX 77573-2988 | 2007-05-22 |
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|---|---|---|---|---|
| 1194326785 | Texas Partners Center | Clinic/Center | 3304 Colorado Blvd Ste 203, Denton, TX 76210-6873 | 2020-11-02 |
| 1730789231 | Zeo Surgical Center LLC | Clinic/Center | 4511 Horizon Hill Blvd Ste 100, San Antonio, TX 78229-2399 | 2020-10-26 |
| 1194323725 | Mission Surgery Center LLC | Clinic/Center | 603 E Amber St, Suite 103, San Antonio, TX 78221-7822 | 2020-10-15 |
| 1083211809 | Forest Landing Surgical Center LLC | Clinic/Center | 9303 New Trails Dr Ste 185, The Woodlands, TX 77381-5009 | 2020-10-05 |
| 1457968430 | Park Ventura Endoscopy Center, LLC | Clinic/Center | 981 State Highway 121, Suite 2100, Allen, TX 75013 | 2020-09-24 |
| 1851904056 | Zenith Surgery Center | Clinic/Center | 10710 Kuykendahl Rd Ste 160, The Woodlands, TX 77381-2695 | 2020-08-26 |
| 1063024719 | Horizon Surgery Center | Clinic/Center | 2813 Smith Ranch Rd Ste 180, Pearland, TX 77584-5254 | 2020-08-22 |
| 1376151944 | Rhythm Endovascular & Heart Asc LLC | Clinic/Center | 5418 N Loop 1604 W Ste 250, San Antonio, TX 78249-1207 | 2020-07-20 |
| 1720603079 | Texas Health Surgery Center Chisholm Trail, LLC | Clinic/Center | 5900 Altamesa Blvd, Fort Worth, TX 76132-5473 | 2020-06-12 |
| 1831714419 | Encor Asc, LLC | Clinic/Center | 103 Whispering Winds Dr, Gunter, TX 75058-2560 | 2020-06-10 |
| Find all providers with the same taxonomy | ||||
| City | LEAGUE CITY |
| Zip Code | 77573 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.