Provider Demographics
NPI:1407100480
Name:SEACREST SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:SEACREST SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGA
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:STYPEREK GROHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-735-7766
Mailing Address - Street 1:2314 S. SEACREST BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-735-7766
Mailing Address - Fax:561-732-2942
Practice Address - Street 1:2314 S SEACREST BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6788
Practice Address - Country:US
Practice Address - Phone:561-735-7766
Practice Address - Fax:561-732-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical