Healthcare Provider Details

I. General information

NPI: 1851006316
Provider Name (Legal Business Name): PREMIER SURGICAL SUITES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 DREW ST STE 100
CLEARWATER FL
33765-3215
US

IV. Provider business mailing address

2111 DREW ST STE 100
CLEARWATER FL
33765-3215
US

V. Phone/Fax

Practice location:
  • Phone: 727-604-5090
  • Fax: 727-442-1600
Mailing address:
  • Phone: 727-604-5090
  • Fax: 727-442-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GINGER URBANIAK
Title or Position: CFO
Credential: MD
Phone: 616-218-4495