Provider Demographics
NPI:1801899687
Name:TRINITY SURGERY CENTER LLC
Entity type:Organization
Organization Name:TRINITY SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-394-6747
Mailing Address - Street 1:PO BOX 100307
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0307
Mailing Address - Country:US
Mailing Address - Phone:727-372-4055
Mailing Address - Fax:727-372-4066
Practice Address - Street 1:2020 TRINITY OAKS BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4402
Practice Address - Country:US
Practice Address - Phone:727-372-4055
Practice Address - Fax:727-372-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1401261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0755109-00Medicaid
FL0941OtherSTATE LICENSE
FL10C0001401Medicare PIN