Healthcare Provider Details

I. General information

NPI: 1679662001
Provider Name (Legal Business Name): WEBSTER SURGICAL CENTER OF TALLAHASSEE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 CENTRE POINTE LN
TALLAHASSEE FL
32308-4300
US

IV. Provider business mailing address

2048 CENTRE POINTE LN
TALLAHASSEE FL
32308-4300
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-0471
  • Fax: 850-942-5733
Mailing address:
  • Phone: 850-878-0471
  • Fax: 850-942-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1140
License Number StateFL

VIII. Authorized Official

Name: MR. THADDEUS J HILL
Title or Position: COO
Credential:
Phone: 850-878-0471