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General NPI Number Information
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NPI Number | 1871594275
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Entity Type | Organization
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Legal Business Name | DESTIN SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1225 AIRPORT RD
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City | DESTIN
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State | FL
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Zip | 32541-2909
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Country | US
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Telephone | 850-650-7606
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Fax | 850-337-1698
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Provider Business Mailing Address
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Address Line | 1225 AIRPORT RD
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City | DESTIN
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State | FL
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Zip | 32541-2909
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Country | US
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Telephone | 850-650-7606
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Fax | 850-337-1698
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Authorized Official
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Title or Position | OFFICER/AUTHORIZE OFFICAL
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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 | 1136
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License Number State | FL
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