Healthcare Provider Details

I. General information

NPI: 1174586606
Provider Name (Legal Business Name): BELLEAIR SURGERY CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 PONCE DE LEON BLVD
CLEARWATER FL
33756-1041
US

IV. Provider business mailing address

1130 PONCE DE LEON BLVD
CLEARWATER FL
33756-1041
US

V. Phone/Fax

Practice location:
  • Phone: 727-581-4800
  • Fax: 727-585-0319
Mailing address:
  • Phone: 727-581-4800
  • Fax: 727-585-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number855
License Number StateFL

VIII. Authorized Official

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