Healthcare Provider Details

I. General information

NPI: 1205184603
Provider Name (Legal Business Name): ST. LUKES SURGICAL AT THE VILLAGES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD CAMP RD BUILDING #230
THE VILLAGES FL
32162-1762
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 352-350-8484
  • Fax:
Mailing address:
  • Phone: 727-943-3111
  • Fax: 727-943-3334

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: MARK H LINDBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 727-943-3111