Healthcare Provider Details

I. General information

NPI: 1891388625
Provider Name (Legal Business Name): LIGHTHOUSE POINT AMBULATORY AND SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 N FEDERAL HWY STE 100
LIGHTHOUSE POINT FL
33064-7058
US

IV. Provider business mailing address

5340 N FEDERAL HWY STE 100
LIGHTHOUSE POINT FL
33064-7058
US

V. Phone/Fax

Practice location:
  • Phone: 954-358-4949
  • Fax:
Mailing address:
  • Phone: 954-358-4949
  • 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: VIPIN GUPTA
Title or Position: OWNER
Credential: MD
Phone: 954-358-4949