Provider Demographics
NPI:1568994689
Name:ST PETERSBURG AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ST PETERSBURG AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-581-8706
Mailing Address - Street 1:148 13TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3127
Mailing Address - Country:US
Mailing Address - Phone:727-450-3030
Mailing Address - Fax:727-450-3031
Practice Address - Street 1:6133 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8529
Practice Address - Country:US
Practice Address - Phone:727-581-8706
Practice Address - Fax:727-450-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical