Healthcare Provider Details

I. General information

NPI: 1093772840
Provider Name (Legal Business Name): THE SURGERY CENTER AT JENSEN BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 NW GOLDEN ROD ROAD
JENSEN BEACH FL
34957
US

IV. Provider business mailing address

3995 NW GOLDEN ROD ROAD
JENSEN BEACH FL
34957
US

V. Phone/Fax

Practice location:
  • Phone: 772-497-0020
  • Fax: 772-497-0021
Mailing address:
  • Phone: 772-497-0020
  • Fax: 772-497-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1197
License Number StateFL

VIII. Authorized Official

Name: COLLIN LEMAISTRE
Title or Position: OFFICER/AUTHORIZED OFFICAL
Credential:
Phone: 214-213-0723