Healthcare Provider Details

I. General information

NPI: 1598965634
Provider Name (Legal Business Name): LAKE CITY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SW PROSPERITY PLACE
LAKE CITY FL
32024
US

IV. Provider business mailing address

208 SW PROSPERITY PLACE
LAKE CITY FL
32024
US

V. Phone/Fax

Practice location:
  • Phone: 386-487-3930
  • Fax: 386-487-3935
Mailing address:
  • Phone: 386-487-3930
  • Fax: 386-487-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1046
License Number StateFL

VIII. Authorized Official

Name: COLLIN LEMAISTRE
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 214-213-0732