Provider Demographics
NPI:1003870825
Name:PINELLAS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PINELLAS SURGERY CENTER, LLC
Other - Org Name:CENTER FOR SPECIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-527-1919
Mailing Address - Street 1:4650 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3802
Mailing Address - Country:US
Mailing Address - Phone:727-527-1919
Mailing Address - Fax:727-527-0714
Practice Address - Street 1:4650 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3802
Practice Address - Country:US
Practice Address - Phone:727-527-1919
Practice Address - Fax:727-527-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL878261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079205500Medicaid
FL079205500Medicaid