Provider Demographics
NPI:1295479780
Name:ADVENTHEALTH SURGERY CENTER DAVENPORT LLC
Entity type:Organization
Organization Name:ADVENTHEALTH SURGERY CENTER DAVENPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-0732
Mailing Address - Street 1:107 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6858
Mailing Address - Country:US
Mailing Address - Phone:863-419-2812
Mailing Address - Fax:863-419-2821
Practice Address - Street 1:107 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6858
Practice Address - Country:US
Practice Address - Phone:863-419-2812
Practice Address - Fax:863-419-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical