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General NPI Number Information
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NPI Number | 1649515354
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Entity Type | Organization
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Legal Business Name | SURGCENTER NORTHEAST LLC
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 5901 E FOWLER AVE STE 200
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2305
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Country | US
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Telephone | 813-972-4905
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Fax | 813-558-6464
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Provider Business Mailing Address
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Address Line | 5901 E FOWLER AVE STE 200
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2305
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Country | US
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Telephone | 813-972-4905
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Fax | 813-558-6464
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | COLLIN LEMAISTRE
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Credential |
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Telephone | 469-250-3640
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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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