Provider Demographics
NPI:1164733473
Name:NORTH HABANA SURGICAL CENTER
Entity Type:Organization
Organization Name:NORTH HABANA SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-872-2696
Mailing Address - Street 1:4214 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6314
Mailing Address - Country:US
Mailing Address - Phone:813-872-2696
Mailing Address - Fax:813-872-0268
Practice Address - Street 1:4214 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6314
Practice Address - Country:US
Practice Address - Phone:813-872-2696
Practice Address - Fax:813-872-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1259261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME54308OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH