MEDICARE: SURGERY CENTER OF FT PIERCE 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

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	:	1972545291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF FT PIERCE LTD

Provider Business Mailing Address
First Line	:	1707 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4709
Country	:	US
Telephone Number	:	772-464-8900
Fax Number	:	772-464-1104

Provider Business Practice Location Address
First Line	:	1707 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4709
Country	:	US
Telephone Number	:	772-464-8900
Fax Number	:	772-464-1104

Authorized Official
Title or Position	:	CFO
Name	:	DON LIEDTKE
Credential	:
Telephone Number	:	614-344-5507

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/23/2008

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Directions to “SURGERY CENTER OF FT PIERCE LTD ” Practice Location

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