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General NPI Number Information
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NPI Number | 1245711803
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Entity Type | Organization
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Legal Business Name | SURGCENTER CLEARWATER, LLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 980 MILWAUKEE AVENUE
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City | DUNEDIN
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State | FL
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Zip | 34698
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Country | US
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Telephone | 330-704-4752
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Fax |
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Provider Business Mailing Address
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Address Line | 8214 SOLANO BAY LOOP APT 513
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City | TAMPA
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State | FL
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Zip | 33635-9561
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Country | US
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Telephone | 330-704-4752
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Fax |
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Authorized Official
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Title or Position | OFFICER/AO
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Name | COLLIN LEMAISTRE
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Credential |
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Telephone | 214-213-0732
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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 |
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License Number State |
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