MEDICARE: COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD

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	261QA1903X	Ambulatory Surgical Clinic/Center	870	FL

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	:	1376507194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD

Provider Business Mailing Address
First Line	:	4302 N GOMEZ AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6312
Country	:	US
Telephone Number	:	813-870-6330
Fax Number	:	813-871-3956

Provider Business Practice Location Address
First Line	:	4302 N GOMEZ AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6312
Country	:	US
Telephone Number	:	813-870-6330
Fax Number	:	813-871-3956

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM G SWINNEY
Credential	:
Telephone Number	:	972-789-2877

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	02/06/2018

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