Provider Demographics
NPI:1962955468
Name:SURGERY CENTERS OF AMERICA, LLC
Entity type:Organization
Organization Name:SURGERY CENTERS OF AMERICA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-933-6228
Mailing Address - Street 1:10909 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1741
Mailing Address - Country:US
Mailing Address - Phone:813-933-6228
Mailing Address - Fax:
Practice Address - Street 1:10909 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1741
Practice Address - Country:US
Practice Address - Phone:813-933-6228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical