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Organization
TAMPA BAY CENTER FOR SPECIALIZED SURGERY INC
Active
Organization
TAMPA BAY CENTER FOR SPECIALIZED SURGERY INC
Active
Other names
CENTER FOR SPECIALIZED SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ELIZABETH DYKEMA (FACILITY ADMINISTATOR)
(813) 874-2040
Entity
Organization
Contact information
Practice address
2808 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6306
(813) 874-2040
(813) 876-3438
Mailing address
PO BOX 152199, TAMPA, FL 33684-2199
(813) 874-2040
(813) 876-3438
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
912
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162422500
ACS
KY
01
—
2173001
AETNA
FL
01
—
593535954200
BWC
OH
01
—
912
STATE OF FLORIDA
FL
Enumeration date
05/28/2006
Last updated
04/10/2013
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