Organization
PEDIATRIC SURGERY CENTER -ODESSA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLIN LEMAISTRE (AUTHORIZED OFFICIAL)
(214) 213-0732
Entity
Organization
Contact information
Practice address
14111 STATE ROAD 54, ODESSA, FL 33556-3663
(813) 343-5690
(813) 792-1845
Mailing address
14111 STATE ROAD 54, ODESSA, FL 33556-3663
(813) 343-5690
(813) 792-1845
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
FL
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000348000
—
FL
05
—
007254600
—
FL
Enumeration date
12/27/2007
Last updated
09/17/2024
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