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General NPI Number Information
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NPI Number | 1518920040
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE SURGERY CENTER, LTD
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 3291 N MCMULLEN BOOTH RD
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City | CLEARWATER
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State | FL
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Zip | 33761-2010
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Country | US
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Telephone | 727-725-5800
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Fax | 727-797-4002
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Provider Business Mailing Address
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Address Line | 3291 N MCMULLEN BOOTH RD
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City | CLEARWATER
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State | FL
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Zip | 33761-2010
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Country | US
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Telephone | 727-725-5800
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Fax | 727-797-4002
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Authorized Official
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Title or Position | VP
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Name | WILLIAM G SWINNEY
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Credential |
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Telephone | 972-789-2877
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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 | 986
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License Number State | FL
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