Healthcare Provider Details

I. General information

NPI: 1043272750
Provider Name (Legal Business Name): WEST PARK SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 78TH AVE SUITE B
PINELLAS PARK FL
33781-2053
US

IV. Provider business mailing address

PO BOX 628781
ORLANDO FL
32862-8781
US

V. Phone/Fax

Practice location:
  • Phone: 727-549-0610
  • Fax: 727-518-8662
Mailing address:
  • Phone: 727-549-0610
  • Fax: 727-549-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TRACIE GARI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 813-549-2134