Provider Demographics
NPI:1265466288
Name:TAMARAC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:TAMARAC SURGERY CENTER LLC
Other - Org Name:THE SURGERY CENTER OF FT LAUDERDALE
Other - Org Type:Doing Business As
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 1:4485 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5876
Mailing Address - Country:US
Mailing Address - Phone:954-735-0096
Mailing Address - Fax:954-735-8212
Practice Address - Street 1:4485 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5876
Practice Address - Country:US
Practice Address - Phone:954-735-0096
Practice Address - Fax:954-735-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1074261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490004691OtherRAILROAD MEDICARE
FL0023073Medicaid
FL0023073Medicaid
FL10C0001302Medicare Oscar/Certification