MEDICARE: WEST FLORIDA SURGERY CENTER INC

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	960	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	612	OTHER		BCBS OF FL
2	00000002	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1508879446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FLORIDA SURGERY CENTER INC

Provider Business Mailing Address
First Line	:	5817 21ST AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5641
Country	:	US
Telephone Number	:	941-794-0379
Fax Number	:	941-798-9905

Provider Business Practice Location Address
First Line	:	5817 21ST AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5641
Country	:	US
Telephone Number	:	941-794-0379
Fax Number	:	941-798-9905

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE W TROTMAN
Credential	:	MD
Telephone Number	:	941-794-0379

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/29/2011

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