Healthcare Provider Details

I. General information

NPI: 1992700090
Provider Name (Legal Business Name): TAMPA BAY SPECIALTY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 66TH STREET NORTH
PINELLAS PARK FL
33781
US

IV. Provider business mailing address

6500 66TH STREET NORTH
PINELLAS PARK FL
33781
US

V. Phone/Fax

Practice location:
  • Phone: 727-828-1460
  • Fax: 727-828-1469
Mailing address:
  • Phone: 727-828-1460
  • Fax: 727-828-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1174
License Number StateFL

VIII. Authorized Official

Name: MR. PHILLIP A. CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283