Healthcare Provider Details

I. General information

NPI: 1215307012
Provider Name (Legal Business Name): BAY AREA SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VONDERBURG DR
BRANDON FL
33511
US

IV. Provider business mailing address

516 VONDERBURG DR
BRANDON FL
33511
US

V. Phone/Fax

Practice location:
  • Phone: 813-699-1200
  • Fax:
Mailing address:
  • Phone: 813-699-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 972-789-2877