Healthcare Provider Details

I. General information

NPI: 1801899687
Provider Name (Legal Business Name): TRINITY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 TRINITY OAKS BLVD
TRINITY FL
34655-4402
US

IV. Provider business mailing address

PO BOX 100307
ATLANTA GA
30384-0307
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-4055
  • Fax: 727-372-4066
Mailing address:
  • Phone: 727-372-4055
  • Fax: 727-372-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberF1401
License Number StateFL

VIII. Authorized Official

Name: MRS. DONNA ST LOUIS
Title or Position: VP
Credential:
Phone: 727-394-6747