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NPI Code Detail

MEDICARE: ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC

MEDICARE: ADVENTHEALTH SURGERY CENTER WELLSWOOD 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1588260343
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC
Provider Business Mailing Address
First Line : 14201 DALLAS PKWY
Second Line :
City : DALLAS
State : TX
Zip : 75254-2916
Country : US
Telephone Number : 972-763-3859
Fax Number : 972-920-3445
Provider Business Practice Location Address
First Line : 5013 N ARMENIA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33603-1403
Country : US
Telephone Number : 813-875-0562
Fax Number : 813-875-1983
Authorized Official
Title or Position : OFFICER/AUTHORIZED OFFICIAL
Name : COLLIN LEMAISTRE
Credential :
Telephone Number : 469-250-3640
Provider Enumeration Date : 12/08/2020
Last Update Date : 09/17/2024

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