Provider Demographics
NPI:1124186663
Name:SOUTH TAMPA SURGERY CENTER, LLC.
Entity Type:Organization
Organization Name:SOUTH TAMPA SURGERY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-873-8700
Mailing Address - Street 1:3600 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2802
Mailing Address - Country:US
Mailing Address - Phone:813-873-8700
Mailing Address - Fax:813-873-0101
Practice Address - Street 1:3600 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2802
Practice Address - Country:US
Practice Address - Phone:813-873-8700
Practice Address - Fax:813-873-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1403Medicare ID - Type Unspecified