MEDICARE: SEASIDE SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1043605934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASIDE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1879 VETERANS PARK DR STE 1101
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0500
Country	:	US
Telephone Number	:	239-592-4955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1879 VETERANS PARK DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0500
Country	:	US
Telephone Number	:	239-248-7623
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	COLLIN LEMAISTRE
Credential	:
Telephone Number	:	404-781-2921

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	09/10/2024

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