1316189095 NPI number — CARILLON SURGERY CENTER LLC

Table of content: (NPI 1316189095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316189095 NPI number — CARILLON SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARILLON SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316189095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-5830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-852-3272
Provider Business Mailing Address Fax Number:
813-635-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CARILLON PKWY
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33716-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-561-2710
Provider Business Practice Location Address Fax Number:
727-561-2770
Provider Enumeration Date:
03/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
VP AMBULATORY SERVICES
Authorized Official Telephone Number:
727-281-3313

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1315 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001037300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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