Provider Demographics
NPI:1942259130
Name:ST ANTHONYS PHYSICIANS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ST ANTHONYS PHYSICIANS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:727-550-4500
Mailing Address - Street 1:705 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1334
Mailing Address - Country:US
Mailing Address - Phone:727-550-4500
Mailing Address - Fax:727-550-4501
Practice Address - Street 1:705 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1334
Practice Address - Country:US
Practice Address - Phone:727-550-4500
Practice Address - Fax:727-550-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1203261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1424Medicare ID - Type UnspecifiedMEDICARE ID