Basic Information
| Provider Information | |||||||||
| NPI: | 1417949280 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLEARWATER AMBULATORY SURGICAL CENTERS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLEARWATER ENDOSCOPY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CORBETT ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337567309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274430100 | ||||||||
| FaxNumber: | 7274614893 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 CORBETT ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337567309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274430100 | ||||||||
| FaxNumber: | 7274614893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | WESTON | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7274430100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 925 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 6805119 | 01 | FL | UNITED HEALTHCARE | OTHER | 1044849 | 01 | FL | AETNA PROVIDER # | OTHER | 62H | 01 | FL | BCBS FL PROVIDER# | OTHER |