Provider Demographics
NPI:1851006316
Name:PREMIER SURGICAL SUITES, LLC
Entity Type:Organization
Organization Name:PREMIER SURGICAL SUITES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:URBANIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-218-4495
Mailing Address - Street 1:2111 DREW ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3215
Mailing Address - Country:US
Mailing Address - Phone:727-604-5090
Mailing Address - Fax:727-442-1600
Practice Address - Street 1:2111 DREW ST STE 100
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3215
Practice Address - Country:US
Practice Address - Phone:727-604-5090
Practice Address - Fax:727-442-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty