Southeastern Outpatient Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1216 Issued in FL

Legal business name

SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC

Practice address

2030 Fleischmann Rd
Tallahassee, FL 32308

Phone

(850) 219-2000

Fax

(850) 877-2138

NPI assigned

Aug 17, 2006

Last updated

Sep 11, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ben J Kirbo, MDNPI 1720096761

Title

Owner President

Phone

(850) 219-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033223367. Details of each certification follow.

• CCN 10C0001499 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 10C0001499

Legal name

SOUTHEASTERN OUTPATIENT SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Aug 24, 2007

Last certification

Mar 5, 2020

Ownership / control type

Proprietary

Facility address

2030 Fleischmann Rd
Tallahassee, FL 32308

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ben J Kirbo, MD

  • Plastic Surgery Physician
  • Tallahassee, FL
  • NPI 1720096761
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1033223367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 FLEISCHMANN RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-219-2000",
            "fax_number": "850-877-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 FLEISCHMANN RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-219-2000",
            "fax_number": "850-877-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "KIRBO",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "850-219-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Radiology Partners LTD
• Southeast Radiology Partners LTD (Radiology Associates of Tallahassee)
• Southeastern Behavioral Health, LLC
• Southeastern Center for Infectious Diseases PA
• Southeastern Dermatology, PA
• Southeastern Plastic Surgery, P.a. (Southeastern Plastic Surgery)
• Southeastern Podiatry Clinic PA
• Southeastern Surgical Group PA
• Southeastern Therapy Services, LLC
• Southeastern Urological Center PA

• Ambulatory Surgical Clinic/Center in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.