Healthcare Provider Details

I. General information

NPI: 1801343496
Provider Name (Legal Business Name): TRADITION SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10080 SW INNOVATION WAY STE 101
PORT ST LUCIE FL
34987-2129
US

IV. Provider business mailing address

10080 SW INNOVATION WAY STE 101
PORT ST LUCIE FL
34987-2129
US

V. Phone/Fax

Practice location:
  • Phone: 772-345-8700
  • Fax:
Mailing address:
  • Phone: 772-345-8700
  • 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: WILLIAM MILO
Title or Position: VP OPERATIONS
Credential:
Phone: 239-249-4941