Provider Demographics
NPI:1780866640
Name:THE NEW PORT RICHEY FL MULTI SPECIALTY ASC LLC
Entity Type:Organization
Organization Name:THE NEW PORT RICHEY FL MULTI SPECIALTY ASC LLC
Other - Org Name:MEADOW LANE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:5652 MEADOWLANE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4005
Mailing Address - Country:US
Mailing Address - Phone:727-847-7522
Mailing Address - Fax:727-845-8912
Practice Address - Street 1:5652 MEADOWLANE ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4005
Practice Address - Country:US
Practice Address - Phone:727-847-7522
Practice Address - Fax:727-845-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1181Medicare PIN
FL10C0001181Medicare Oscar/Certification