Provider Demographics
NPI:1417055005
Name:SURGICAL ASSOCIATES OF EAST TEXAS, LLP
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF EAST TEXAS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-595-6680
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-0150
Mailing Address - Country:US
Mailing Address - Phone:903-595-6680
Mailing Address - Fax:903-592-1934
Practice Address - Street 1:704 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2014
Practice Address - Country:US
Practice Address - Phone:903-595-6680
Practice Address - Fax:903-592-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCD3048OtherRAILROAD MEDICARE
TXCD3048OtherRAILROAD MEDICARE