Provider Demographics
NPI:1700190352
Name:SAFETY HARBOR SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SAFETY HARBOR SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-789-8770
Mailing Address - Street 1:3280 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2029
Mailing Address - Country:US
Mailing Address - Phone:727-789-8770
Mailing Address - Fax:727-789-8784
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2029
Practice Address - Country:US
Practice Address - Phone:727-789-8770
Practice Address - Fax:727-789-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical