Provider Demographics
NPI:1023225307
Name:SURGICAL SERVICES OF WEST FLORIDA, LLC
Entity type:Organization
Organization Name:SURGICAL SERVICES OF WEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHORTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-955-1231
Mailing Address - Street 1:PO BOX 15074
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1074
Mailing Address - Country:US
Mailing Address - Phone:941-955-1231
Mailing Address - Fax:941-378-3444
Practice Address - Street 1:5741 BEE RIDGE ROAD
Practice Address - Street 2:SUITE 590
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-955-1231
Practice Address - Fax:941-378-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28317Medicare ID - Type Unspecified
FLE89468Medicare UPIN