Healthcare Provider Details

I. General information

NPI: 1346662186
Provider Name (Legal Business Name): NATIONAL SURGICAL CENTERS OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW CHAMBER CT. SUITE 105
PORT ST. LUCIE FL
34986-3413
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 405
MIAMI FL
33155-5506
US

V. Phone/Fax

Practice location:
  • Phone: 772-807-9000
  • Fax: 772-807-9087
Mailing address:
  • Phone: 469-458-9222
  • Fax: 540-918-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1372
License Number StateFL

VIII. Authorized Official

Name: SHANEKA TINCH
Title or Position: RCM MANAGER
Credential:
Phone: 469-458-9222