Healthcare Provider Details

I. General information

NPI: 1598729329
Provider Name (Legal Business Name): SURGICARE OF ST ANDREWS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E VENICE AVE
VENICE FL
34285-9066
US

IV. Provider business mailing address

1350 E VENICE AVE
VENICE FL
34285-9066
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-2030
  • Fax: 941-484-2010
Mailing address:
  • Phone: 941-488-2030
  • Fax: 941-484-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number992
License Number StateFL

VIII. Authorized Official

Name: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 972-789-2877