Provider Demographics
NPI:1326047101
Name:ST. LUCY'S OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ST. LUCY'S OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:ST. LUCY'S OUTPATIENT SURGERY CENTER, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-277-5549
Mailing Address - Street 1:21275 OLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6704
Mailing Address - Country:US
Mailing Address - Phone:941-625-1325
Mailing Address - Fax:941-625-0131
Practice Address - Street 1:21275 OLEAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6704
Practice Address - Country:US
Practice Address - Phone:941-625-1325
Practice Address - Fax:941-625-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79068100Medicaid
FL1326047101Medicare PIN