MEDICARE: SPECIALTYCARE SURGICAL ASSIST, LLC

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	363AS0400X	Surgical Physician Assistant

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	:	1740395748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTYCARE SURGICAL ASSIST, LLC

Provider Business Mailing Address
First Line	:	3 MARYLAND FARMS STE 200
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5005
Country	:	US
Telephone Number	:	615-345-5400
Fax Number	:	615-345-5405

Provider Business Practice Location Address
First Line	:	2240 W WOOLBRIGHT RD STE 210
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6363
Country	:	US
Telephone Number	:	800-348-4565
Fax Number	:	615-345-5405

Authorized Official
Title or Position	:	CFO & TREASURER
Name	:	MR. JEFFREY T GRAY
Credential	:
Telephone Number	:	615-345-5550

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/20/2018

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