Provider Demographics
NPI:1003813221
Name:UNIVERSITY SURGERY CENTER LTD
Entity Type:Organization
Organization Name:UNIVERSITY SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-250-3640
Mailing Address - Street 1:14201 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2916
Mailing Address - Country:US
Mailing Address - Phone:407-677-0066
Mailing Address - Fax:407-677-4199
Practice Address - Street 1:7251 UNIVERSITY BLVD
Practice Address - Street 2:STE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8659
Practice Address - Country:US
Practice Address - Phone:407-677-0066
Practice Address - Fax:407-677-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL890261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO30482OtherSOUTHCARE
FL102150OtherAV-MED
5481709OtherAETNA PPO
FL63ROtherBCBS
FL079153900Medicaid
31315OtherORANGE COUNTY MEDICAL CEN
757603OtherFIRSTHEALTH CCN
21273OtherWELLCARE
1003106OtherCAREPLUS
201347OtherAMERIGROUP
2106036OtherAETNA HMO
68-00006OtherUNITED
5481709OtherAETNA PPO
FL63ROtherBCBS
757603OtherFIRSTHEALTH CCN
5481709OtherAETNA PPO
757603OtherFIRSTHEALTH CCN
=========OtherBEECH STREET