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General NPI Number Information
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NPI Number | 1184680225
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Entity Type | Organization
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Legal Business Name | CAPITAL CITY SURGICAL CENTER LLC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 2807 CAPITAL MEDICAL BLVD STE 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-8420
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Country | US
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Telephone | 850-933-1885
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Fax | 850-309-7422
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Provider Business Mailing Address
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Address Line | 2807-2 CAPITAL MEDICAL BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4405
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Country | US
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Telephone | 850-933-1885
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Fax | 850-309-7422
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BETTY LEICHUS
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Credential |
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Telephone | 850-933-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | PENDING
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License Number State | FL
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