EASTLAKE SURGICAL ASSOCIATES, LLC (NPI# 1780163378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780163378 |
| Entity Type | Organization |
| Organization Name | EASTLAKE SURGICAL ASSOCIATES, LLC |
| Practice Address |
9870 Twin Shores Dr Willis TX 77318 |
| Mailing Address |
9870 Twin Shores Dr Willis TX 77318-6656 |
| Practice Telephone | 9364447071 |
| Mailing Telephone | 9364447071 |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-14 |
| Authorized Official Name | TIFFANY BROOKE MORELAND (LICENSED SURGICAL ASSISTANT) |
| Authorized Official Telephone | 9364447071 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
SA00639 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
9870 TWIN SHORES DR |
| City | WILLIS |
| State | TX |
| Zip Code | 77318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435195 | Scott Sadlowski | Pharmacist | 12605 I-45 N, Willis, TX 77318 | 2020-10-21 |
| 1720621246 | Best Urgent Care, Pllc | Clinic/Center | 12717 Ih 45, Suite 300, Willis, TX 77318 | 2019-10-28 |
| 1962944330 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 9663 W. Fm 1097, Willis, TX 77318 | 2016-11-16 |
| 1730636416 | Dorothy's Halo Non-emergency Transportation Services | Non-emergency Medical Transport (VAN) | 9700 Fm 1097 Rd West, Apt #1003, Willis, TX 77318 | 2016-09-09 |
| 1952474264 | Kroger Texas L P | Durable Medical Equipment & Medical Supplies | 12605 I 45 North, Willis, TX 77318 | 2006-11-16 |
| 1841280054 | Ahia No Middle Name Shabaaz | Registered Nurse | 15713 Lakeway Dr, Willis, TX 77318-3181 | 2005-10-27 |
| 1790795607 | Nathan R Denny | Psychologist | 14079 Lakepoint Dr, Willis, TX 77318-3269 | 2006-08-09 |
| 1184163123 | Skyline Senior Services, LLC | In Home Supportive Care | 13287 Hidden Trail Ct, Willis, TX 77318-4282 | 2017-02-22 |
| 1457639536 | Meridex Group LLC | Hospice Care, Community Based | 14450 Longstreet Rd, Suite B, Willis, TX 77318-4602 | 2011-07-24 |
| 1003195793 | Jacqueline Denise Sparks | Community/Behavioral Health | 12552 Canyon Hill Dr, Willis, TX 77318-4641 | 2011-08-11 |
| Find all providers in zip 77318 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184933616 | Lisa D Weiler | Physician Assistant | 14600 County Line Rd, Willis, TX 77378-4044 | 2010-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275133340 | Mark Alan Williams | Physician Assistant | 4814 Lake Livingston Dr, Corpus Christi, TX 78413-5139 | 2020-10-28 |
| 1669081238 | Manuel V Leyva | Physician Assistant | 8407 Sunset Loch Dr, Spring, TX 77379-5121 | 2020-07-29 |
| 1194342212 | Sean Robert Jamieson | Physician Assistant | 2700 E Broad St Ste 200, Mansfield, TX 76063-5899 | 2020-07-06 |
| 1588284194 | Hill Country Surgical Management, Inc | Physician Assistant | 10454 Tippecanoe, San Antonio, TX 78245-3128 | 2020-04-23 |
| 1407475585 | Serenity Surgical Services | Physician Assistant | 3260 Springbok Cir, Frisco, TX 75034-3671 | 2020-04-09 |
| 1720610470 | Surgical Assistants of South Texas | Physician Assistant | 3414 Highway 146 S, La Porte, TX 77571-7400 | 2020-02-11 |
| 1710524103 | R & H Surgical Services, LLC | Physician Assistant | 14507 Parkesgate Dr, Houston, TX 77083-5792 | 2019-12-04 |
| 1639711195 | Landry & Kiejna Surgical Assisting | Physician Assistant | 1120 Business Center Dr Ste 110, Houston, TX 77043-2735 | 2019-10-16 |
| 1912558693 | Chandrant Akshar Pa | Physician Assistant | 400 W Arbrook Blvd Ste 230, Arlington, TX 76014-3174 | 2019-09-24 |
| 1700435831 | Christina A Vogel-rosbrook | Physician Assistant | 4330 Medical Drive, Suite 120, San Antonio, TX 78229-3353 | 2019-09-11 |
| Find all providers with the same taxonomy | ||||
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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.