Healthcare Provider Details

I. General information

NPI: 1386381408
Provider Name (Legal Business Name): CYPRESS AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 WELLNESS AVE
ORANGE CITY FL
32763-8396
US

IV. Provider business mailing address

2863 WELLNESS AVE
ORANGE CITY FL
32763-8396
US

V. Phone/Fax

Practice location:
  • Phone: 386-297-7239
  • Fax: 386-297-7248
Mailing address:
  • Phone:
  • 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: COLLIN LEMAISTRE
Title or Position: OFFICER/AO
Credential:
Phone: 214-213-0732