Healthcare Provider Details

I. General information

NPI: 1174993679
Provider Name (Legal Business Name): FIRST COAST SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OCALA RD SUITE 300-346
TALLAHASSEE FL
32304-1669
US

IV. Provider business mailing address

PO BOX 96024
LAS VEGAS NV
89195-6024
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-8732
  • Fax: 520-258-0304
Mailing address:
  • Phone: 520-323-8732
  • Fax: 520-258-0304

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: LACEY DINH
Title or Position: REVENUE CYCLE MANAGER OF ABS
Credential:
Phone: 520-258-0326