MEDICARE: TRINITY SURGERY 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	F1401	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0941	OTHER	FL	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801899687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 100307
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0307
Country	:	US
Telephone Number	:	727-372-4055
Fax Number	:	727-372-4066

Provider Business Practice Location Address
First Line	:	2020 TRINITY OAKS BLVD
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-4402
Country	:	US
Telephone Number	:	727-372-4055
Fax Number	:	727-372-4066

Authorized Official
Title or Position	:	VP
Name	:	MRS. DONNA ST LOUIS
Credential	:
Telephone Number	:	727-394-6747

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/02/2015

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