MEDICARE: SEACREST 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	261QA1903X	Ambulatory Surgical Clinic/Center		FL

General Provider Information

NPI Number	:	1407100480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEACREST SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	2314 S. SEACREST BLVD.
Second Line	:	SUITE 201
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435
Country	:	US
Telephone Number	:	561-735-7766
Fax Number	:	561-732-2942

Provider Business Practice Location Address
First Line	:	2314 S SEACREST BLVD
Second Line	:	SUITE 201
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6788
Country	:	US
Telephone Number	:	561-735-7766
Fax Number	:	561-732-2942

Authorized Official
Title or Position	:	PRESIDENT-CEO
Name	:	DR. KINGA EVA STYPEREK GROHMANN
Credential	:	M.D.
Telephone Number	:	561-735-7766

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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Directions to “SEACREST SURGICAL CENTER LLC ” Practice Location

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