Provider Demographics
NPI:1184680225
Name:CAPITAL CITY SURGICAL CENTER LLC
Entity type:Organization
Organization Name:CAPITAL CITY SURGICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-933-1885
Mailing Address - Street 1:2807-2 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4405
Mailing Address - Country:US
Mailing Address - Phone:850-933-1885
Mailing Address - Fax:850-309-7422
Practice Address - Street 1:2807 CAPITAL MEDICAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8420
Practice Address - Country:US
Practice Address - Phone:850-933-1885
Practice Address - Fax:850-309-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical