Provider Demographics
NPI:1720033293
Name:CLINIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CLINIC SURGERY CENTER, LLC
Other - Org Name:NEW TAMPA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/BOARD MEMBER OF CLINIC SU
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:OHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-843-2355
Mailing Address - Street 1:2407 CYPRESS RIDGE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-0004
Mailing Address - Country:US
Mailing Address - Phone:813-991-7575
Mailing Address - Fax:813-335-5085
Practice Address - Street 1:2407 CYPRESS RIDGE BOULEVARD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-0004
Practice Address - Country:US
Practice Address - Phone:813-991-7575
Practice Address - Fax:813-335-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical