Healthcare Provider Details

I. General information

NPI: 1063453082
Provider Name (Legal Business Name): ST LUKES SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

IV. Provider business mailing address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-2020
  • Fax: 727-943-3334
Mailing address:
  • Phone: 727-938-2020
  • Fax: 727-943-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON DAVIS
Title or Position: CREDENTIALING/BILLING SUPERVISOR
Credential:
Phone: 727-943-3111