Healthcare Provider Details

I. General information

NPI: 1417055005
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF EAST TEXAS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S FLEISHEL AVE
TYLER TX
75701-2014
US

IV. Provider business mailing address

PO BOX 150
TYLER TX
75710-0150
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-6680
  • Fax: 903-592-1934
Mailing address:
  • Phone: 903-595-6680
  • Fax: 903-592-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES H. LEE
Title or Position: PARTNER
Credential: M.D.
Phone: 903-595-6680