Provider Demographics
NPI:1487280608
Name:LAKESHORE SURGICAL CENTER LLC
Entity type:Organization
Organization Name:LAKESHORE SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VIM
Authorized Official - Middle Name:X
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-825-4607
Mailing Address - Street 1:6701 LAKE WOODLANDS DR STE 175
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2565
Mailing Address - Country:US
Mailing Address - Phone:281-825-4607
Mailing Address - Fax:
Practice Address - Street 1:6701 LAKE WOODLANDS DR STE 175
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-2565
Practice Address - Country:US
Practice Address - Phone:281-825-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty