Basic Information
| Provider Information | |||||||||
| NPI: | 1508879446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST FLORIDA SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5817 21ST AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342095641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417940379 | ||||||||
| FaxNumber: | 9417989905 | ||||||||
| Practice Location | |||||||||
| Address1: | 5817 21ST AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342095641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417940379 | ||||||||
| FaxNumber: | 9417989905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | ZALEPUGA | ||||||||
| AuthorizedOfficialFirstName: | RIMANTAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9417611800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 960 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 612 | 01 | BCBS OF FL | OTHER | 00000002 | 01 | FL | AHCA | OTHER |