Provider Demographics
NPI:1679662001
Name:WEBSTER SURGICAL CENTER OF TALLAHASSEE LLC.
Entity Type:Organization
Organization Name:WEBSTER SURGICAL CENTER OF TALLAHASSEE LLC.
Other - Org Name:WEBSTER SURGICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-0471
Mailing Address - Street 1:2048 CENTRE POINTE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4300
Mailing Address - Country:US
Mailing Address - Phone:850-878-0471
Mailing Address - Fax:850-942-5733
Practice Address - Street 1:2048 CENTRE POINTE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4300
Practice Address - Country:US
Practice Address - Phone:850-878-0471
Practice Address - Fax:850-942-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1140261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075409900Medicaid
FL075409900Medicaid