MEDICARE: SURGICAL SPECIALISTS OF ST LUCIE

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	1570	FL

General Provider Information

NPI Number	:	1164719209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALISTS OF ST LUCIE

Provider Business Mailing Address
First Line	:	12350 NW 39TH ST STE 200
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2414
Country	:	US
Telephone Number	:	954-248-3422
Fax Number	:

Provider Business Practice Location Address
First Line	:	6830 S US HIGHWAY 1
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-1410
Country	:	US
Telephone Number	:	772-873-6700
Fax Number	:	772-465-5499

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	ALLEN LICHT
Credential	:
Telephone Number	:	954-906-9536

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	06/16/2023

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