Provider Demographics
NPI:1942715826
Name:SAFETY HARBOR ASC COMPANY LLC
Entity Type:Organization
Organization Name:SAFETY HARBOR ASC COMPANY LLC
Other - Org Name:SAFETY HARBOR SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:3280 N MCMULLEN BOOTH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2046
Mailing Address - Country:US
Mailing Address - Phone:727-787-3000
Mailing Address - Fax:727-787-3008
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD STE 110
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2046
Practice Address - Country:US
Practice Address - Phone:727-787-3000
Practice Address - Fax:727-787-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical