1003813221 NPI number — UNIVERSITY SURGERY CENTER LTD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813221 NPI number — UNIVERSITY SURGERY CENTER LTD

Employer Identification Number (EIN):

Provider Organization Name:

UNIVERSITY SURGERY CENTER LTD

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1003813221

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

12/30/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

14201 DALLAS PKWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75254-2916

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

407-677-0066

Provider Business Mailing Address Fax Number:

407-677-4199

Provider First Line Business Practice Location Address:

7251 UNIVERSITY BLVD

Provider Second Line Business Practice Location Address:

STE 100

Provider Business Practice Location Address City Name:

WINTER PARK

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32792-8659

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

407-677-0066

Provider Business Practice Location Address Fax Number:

407-677-4199

Provider Enumeration Date:

07/01/2005

Authorized Official Last Name:

LEMAISTRE

Authorized Official First Name:

COLLIN

Authorized Official Middle Name:

Authorized Official Title or Position:

OFFICER/AUTHORIZED OFFICIAL

Authorized Official Telephone Number:

469-250-3640

• Taxonomy code: 261QA1903X , with the licence number:  890 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: PO30482 . This is a "SOUTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 102150 . This is a "AV-MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 5481709 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 63R . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 079153900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 31315 . This is a "ORANGE COUNTY MEDICAL CEN" identifier . This identifiers is of the category "OTHER".
• Identifier: 757603 . This is a "FIRSTHEALTH CCN" identifier . This identifiers is of the category "OTHER".
• Identifier: 21273 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1003106 . This is a "CAREPLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 201347 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 2106036 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 68-00006 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
• Identifier: 079153900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".