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SOUTHLAKE SURGERY CENTER, LLC
NPI 1013218601
Clinic/Center - Ambulatory Surgical in Southlake, TX

Active since November 12, 2010CLIA 45D2032368 · Waiver
521 W SOUTHLAKE BLVD, SUITE 175, SOUTHLAKE, TX 76092(817) 328-2100(817) 328-2103 Get Directions Write a Review

NPPES record last updated: November 12, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southlake Surgery Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHLAKE SURGERY CENTER, LLC (NPI 1013218601) is a healthcare organization registered as an ambulatory surgical in Southlake, Texas and active in the NPI registry since November 2010. The organization holds a CLIA Waiver certificate valid through November 7, 2027 and lists Jonathan Heistein, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1013218601
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSOUTHLAKE SURGERY CENTER, LLC
Location Address521 W SOUTHLAKE BLVD, SUITE 175Southlake, TX 76092-6173
Mailing Address521 W Southlake Blvd, Suite 175Southlake, TX 76092-6173 · (817) 328-2100 · Fax (817) 328-2103
Phone(817) 328-2100
Fax(817) 328-2103
Organization SubpartNo
Authorized OfficialJonathan HeisteinMedical Director · (817) 328-2100
Enumeration DateNovember 12, 2010
✔ NPI 1013218601 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
521 W SOUTHLAKE BLVD, Southlake, TX 76092
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2032368

Southlake Surgery Center · Southlake, TX
Active · expires Nov 7, 2027
CLIA Number45D2032368
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateNovember 8, 2025
Certificate Expiration DateNovember 7, 2027
Laboratory DirectorJonathan B. Heistein
Laboratory Phone(817) 328-2100
Laboratory LocationSouthlake Surgery Center521 W Southlake Blvd, Suite 175, Southlake, TX 76092
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NEURO BRAIN CENTER OF AMERICA, LLC
Specialist/Technologist, Other (Electroneurodiagnostic)
521 W SOUTHLAKE BLVD, SUITE 100
SOUTHLAKE, TX 76092
Tarrant County (817) 488-3238

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southlake Surgery Center, LLC's NPI number?

The NPI number for Southlake Surgery Center, LLC is 1013218601. It was assigned to this organization in the NPPES registry on November 12, 2010.

Where is Southlake Surgery Center, LLC located?

Southlake Surgery Center, LLC is located at 521 W Southlake Blvd Suite 175, Southlake, TX 76092. The listed phone number is (817) 328-2100.

What is Southlake Surgery Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Southlake Surgery Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2032368) is associated with this NPI, valid through November 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southlake Surgery Center, LLC was last updated on November 12, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.