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NPI Code Detail

MEDICARE: DESTIN SURGERY CENTER LLC

MEDICARE: DESTIN 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
1261QA1903XAmbulatory Surgical Clinic/Center1136FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2490005522OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871594275
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESTIN SURGERY CENTER LLC
Provider Business Mailing Address
First Line : 1225 AIRPORT RD
Second Line :
City : DESTIN
State : FL
Zip : 32541-2909
Country : US
Telephone Number : 850-650-7606
Fax Number : 850-337-1698
Provider Business Practice Location Address
First Line : 1225 AIRPORT RD
Second Line :
City : DESTIN
State : FL
Zip : 32541-2909
Country : US
Telephone Number : 850-650-7606
Fax Number : 850-337-1698
Authorized Official
Title or Position : OFFICER/AUTHORIZE OFFICAL
Name : COLLIN LEMAISTRE
Credential :
Telephone Number : 214-213-0732
Provider Enumeration Date : 08/09/2005
Last Update Date : 09/19/2024

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Directions to “DESTIN SURGERY CENTER LLC ” Practice Location

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