Provider Demographics
NPI:1154956928
Name:ADVANCED SURGICAL CARE OF CLEARWATER LLC
Entity type:Organization
Organization Name:ADVANCED SURGICAL CARE OF CLEARWATER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-0723
Mailing Address - Street 1:93 N PARK PLACE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3929
Mailing Address - Country:US
Mailing Address - Phone:727-742-3564
Mailing Address - Fax:
Practice Address - Street 1:93 N PARK PLACE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3917
Practice Address - Country:US
Practice Address - Phone:727-742-3564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical