Provider Demographics
NPI:1730112129
Name:TREASURE COAST SURGERY, INC.
Entity Type:Organization
Organization Name:TREASURE COAST SURGERY, INC.
Other - Org Name:TREASURE COAST CENTER FOR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-286-9656
Mailing Address - Street 1:1411 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2651
Mailing Address - Country:US
Mailing Address - Phone:772-286-8028
Mailing Address - Fax:772-283-6628
Practice Address - Street 1:1411 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2651
Practice Address - Country:US
Practice Address - Phone:772-286-8028
Practice Address - Fax:772-283-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1002261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66AOtherBLUE CROSS/BLUE SHIELD
FL66AOtherBLUE CROSS/BLUE SHIELD