1801899687 NPI number — TRINITY SURGERY CENTER LLC

Table of content: (NPI 1801899687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801899687 NPI number — TRINITY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY 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:
BAYCARE SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1801899687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100307
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:
30384-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-372-4055
Provider Business Mailing Address Fax Number:
727-372-4066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 TRINITY OAKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-372-4055
Provider Business Practice Location Address Fax Number:
727-372-4066
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ST LOUIS
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
727-394-6747

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  F1401 , 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: 0755109-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0941 . This is a "STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 075510900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".