Organization
ST. LUCIE SURGICAL CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANJANAYA PRASAD KORLIPARA M.D. (PRESIDENT)
(772) 429-5201
Entity
Organization
Contact information
Practice address
1300 N LAWNWOOD CIR, FORT PIERCE, FL 34950-4884
(772) 429-5201
(772) 429-5204
Mailing address
1300 N LAWNWOOD CIR, FORT PIERCE, FL 34950-4884
(772) 429-5201
(772) 429-5204
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1107
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070735000
—
FL
Enumeration date
12/16/2005
Last updated
02/20/2012
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