Provider Demographics
NPI:1396796249
Name:TAMPA BAY SURGERY CENTER ASSOCIATES, LTD.
Entity type:Organization
Organization Name:TAMPA BAY SURGERY CENTER ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-961-8500
Mailing Address - Street 1:11811 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3505
Mailing Address - Country:US
Mailing Address - Phone:813-961-8500
Mailing Address - Fax:831-265-2564
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-357-5905
Practice Address - Fax:813-874-2509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMPA BAY SURGERY CENTER ASSOCIATES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1211261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075986400Medicaid
FLF1442Medicare ID - Type Unspecified