MEDICARE: SURGCENTER PINELLAS, 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	:	1881905792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGCENTER PINELLAS, LLC

Provider Business Mailing Address
First Line	:	12416 66TH ST STE D
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3430
Country	:	US
Telephone Number	:	727-408-5310
Fax Number	:	727-531-0360

Provider Business Practice Location Address
First Line	:	12416 66TH ST N
Second Line	:	STE D
City	:	LARGO
State	:	FL
Zip	:	33773-3430
Country	:	US
Telephone Number	:	727-408-5310
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	COLLIN LEMAISTRE
Credential	:
Telephone Number	:	404-781-2921

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	09/10/2024

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