Healthcare Provider Details

I. General information

NPI: 1790252864
Provider Name (Legal Business Name): TREASURE COAST ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 SE MONTEREY ROAD EXT
STUART FL
34994-4617
US

IV. Provider business mailing address

1155 SE MONTEREY ROAD EXT
STUART FL
34994-4617
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 Number
License Number State

VIII. Authorized Official

Name: COLLIN LEMAISTRE
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168