| Organization Name: | ST MARY SURGICAL INC |
| NPI Number: | 1649480146 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMGED GAMIL YOUNAN (SURGICAL ASSISTANT CERTIFIED SA-C) |
| Mailing Address: | 5343 59th Circle West Kenneth City |
| State: | FL US |
| Postal Code: | 33709 |
| Phone Number: | 7274172151 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | SA-C # 05-254 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |