Basic Information
| Provider Information | |||||||||
| NPI: | 1588260343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC | ||||||||
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| OtherOrganizationName: | ADVENTHEALTH SURGERY CENTER WELLSWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14201 DALLAS PKWY | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752542916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727633859 | ||||||||
| FaxNumber: | 9729203445 | ||||||||
| Practice Location | |||||||||
| Address1: | 5013 N ARMENIA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336031403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138750562 | ||||||||
| FaxNumber: | 8138751983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2020 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEMAISTRE | ||||||||
| AuthorizedOfficialFirstName: | COLLIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4692503640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.