Provider Demographics
NPI:1700602612
Name:EAST SHORE SURGERY CENTER LLC
Entity type:Organization
Organization Name:EAST SHORE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:AWASUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-576-8418
Mailing Address - Street 1:1006 WINDSOR LAKES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1006 WINDSOR LAKES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4974
Practice Address - Country:US
Practice Address - Phone:346-237-5899
Practice Address - Fax:888-391-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical