MEDICARE: TAMPA BAY SPECIALTY SURGERY CENTER 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	261QA1903X	Ambulatory Surgical Clinic/Center	1174	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00095116	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1992700090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY SPECIALTY SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	6500 66TH STREET NORTH
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781
Country	:	US
Telephone Number	:	727-828-1460
Fax Number	:	727-828-1469

Provider Business Practice Location Address
First Line	:	6500 66TH STREET NORTH
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781
Country	:	US
Telephone Number	:	727-828-1460
Fax Number	:	727-828-1469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PHILLIP A. CLENDENIN
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/07/2023

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