MEDICARE: EASTSIDE SURGERY CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124135918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE SURGERY CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 1643
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-1643
Country	:	US
Telephone Number	:	800-249-3478
Fax Number	:	713-451-4383

Provider Business Practice Location Address
First Line	:	10918 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1912
Country	:	US
Telephone Number	:	713-451-4299
Fax Number	:	713-451-4383

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	DEBBIE ROSS
Credential	:
Telephone Number	:	281-772-7749

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/21/2020

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Directions to “EASTSIDE SURGERY CENTER INC ” Practice Location

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