Healthcare Provider Details

I. General information

NPI: 1730112129
Provider Name (Legal Business Name): TREASURE COAST SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 SE OCEAN BLVD
STUART FL
34996-2651
US

IV. Provider business mailing address

1411 SE OCEAN BLVD
STUART FL
34996-2651
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-8028
  • Fax: 772-283-6628
Mailing address:
  • Phone: 772-286-8028
  • Fax: 772-283-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1002
License Number StateFL

VIII. Authorized Official

Name: MRS. ANDREA L DAY
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 772-286-9656