MEDICARE: LONGLEAF 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

General Provider Information

NPI Number	:	1831525112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGLEAF SURGERY CENTER, 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	:	3000 STARKEY BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2175
Country	:	US
Telephone Number	:	609-575-5854
Fax Number	:	609-575-5854

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	COLLIN LEMAISTRE
Credential	:
Telephone Number	:	469-250-3640

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	02/17/2026

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