Provider Demographics
NPI:1558564344
Name:SURGERY CENTER OF ATLANTIS LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF ATLANTIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-689-2877
Mailing Address - Street 1:5645 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6978
Mailing Address - Country:US
Mailing Address - Phone:561-964-3966
Mailing Address - Fax:561-964-3995
Practice Address - Street 1:5645 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6978
Practice Address - Country:US
Practice Address - Phone:561-964-3966
Practice Address - Fax:561-964-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1431Medicare PIN