PEDIATRIC SURGERY CENTER -ODESSA LLC NPI 1750565594

NPI Information

NPI: 1750565594
Provider Name: PEDIATRIC SURGERY CENTER -ODESSA, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 10D1080435

Address:
14111 STATE ROAD 54
ODESSA, FL
ZIP 33556
Phone: (813) 343-5690
Get Directions

PEDIATRIC SURGERY CENTER -ODESSA, LLC is an ambulatory surgical clinic center in Odessa, FL. PEDIATRIC SURGERY CENTER -ODESSA, LLC NPI is 1750565594. The provider is registered as an organization entity type.

The provider's business location address is:

14111 STATE ROAD 54
ODESSA, FL
ZIP 33556-663
Phone: (813) 343-5690
Fax: (813) 792-1845

The provider's authorized official is Jenetha D Moran .
The authorized official title is Authorized Official and has the following contact phone number (972) 763-3893.

The CLIA number assigned to this NPI record is 10D1080435 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/27/2007 and was last updated on 7/26/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical		FLORIDA	No
2	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000348000	MEDICAID	FLORIDA
2	007254600	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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