Provider Demographics
NPI:1730118555
Name:HARBORSIDE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HARBORSIDE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-833-1104
Mailing Address - Street 1:610 E OLYMPIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3875
Mailing Address - Country:US
Mailing Address - Phone:941-637-0065
Mailing Address - Fax:941-639-6545
Practice Address - Street 1:610 E OLYMPIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3875
Practice Address - Country:US
Practice Address - Phone:941-637-0065
Practice Address - Fax:941-639-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10C0001220261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079174100Medicaid
FL079174100Medicaid