MEDICARE: TAMPA BAY HEALTH SURGICAL 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	261Q00000X	Clinic/Center	ME97230	FL

General Provider Information

NPI Number	:	1386046209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY HEALTH SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	3970 MARIETTA WAY
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-8712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 T G LEE BLVD
Second Line	:	SUITE 340
City	:	ORLANDO
State	:	FL
Zip	:	32822-4407
Country	:	US
Telephone Number	:	813-463-6578
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. ANA SOLES
Credential	:
Telephone Number	:	813-463-6578

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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