Healthcare Provider Details

I. General information

NPI: 1720911316
Provider Name (Legal Business Name): TAMPA BAY SURGERY CENTER MIDTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MLK BLVD STE 150
TAMPA FL
33607-6003
US

IV. Provider business mailing address

2727 W DR MLK BLVD STE 150
TAMPA FL
33607-6003
US

V. Phone/Fax

Practice location:
  • Phone: 813-961-8500
  • Fax: 831-265-2564
Mailing address:
  • Phone: 813-961-8500
  • Fax: 831-265-2564

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: JACK ELLIS
Title or Position: REGIONAL VICE PRESIDENT OPERATIONS
Credential:
Phone: 763-464-9779