Healthcare Provider Details

I. General information

NPI: 1407100480
Provider Name (Legal Business Name): SEACREST SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 S SEACREST BLVD SUITE 201
BOYNTON BEACH FL
33435-6788
US

IV. Provider business mailing address

2314 S. SEACREST BLVD. SUITE 201
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-735-7766
  • Fax: 561-732-2942
Mailing address:
  • Phone: 561-735-7766
  • Fax: 561-732-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. KINGA EVA STYPEREK GROHMANN
Title or Position: PRESIDENT-CEO
Credential: M.D.
Phone: 561-735-7766