Provider Demographics
NPI:1538415260
Name:LAKEWOOD SURGICAL ASSOCIATES LP
Entity type:Organization
Organization Name:LAKEWOOD SURGICAL ASSOCIATES LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-547-6170
Mailing Address - Street 1:9219 GARLAND RD STE 2107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4639
Mailing Address - Country:US
Mailing Address - Phone:469-547-6170
Mailing Address - Fax:469-547-6180
Practice Address - Street 1:9219 GARLAND RD STE 2107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4639
Practice Address - Country:US
Practice Address - Phone:469-547-6170
Practice Address - Fax:469-547-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty