MEDICARE: LINEBAUGH SURGERY CENTER

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	OSR1258	FL

General Provider Information

NPI Number	:	1851804561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINEBAUGH SURGERY CENTER

Provider Business Mailing Address
First Line	:	4104 W LINEBAUGH AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5239
Country	:	US
Telephone Number	:	812-229-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	4104 W LINEBAUGH AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5239
Country	:	US
Telephone Number	:	812-229-2225
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. EDWARD LEONARD
Credential	:	DC
Telephone Number	:	813-786-2339

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	11/16/2017

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Directions to “LINEBAUGH SURGERY CENTER ” Practice Location

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