1063495257 NPI number — DOCTORS SURGICAL PARTNERSHIP LLC

Table of content: (NPI 1063495257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063495257 NPI number — DOCTORS SURGICAL PARTNERSHIP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS SURGICAL PARTNERSHIP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MELBOURNE SAME DAY SURGERY
Provider Other Organization Name Type Code:
3
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 Information

NPI Number:
1063495257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 562750
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-434-5491
Provider Business Mailing Address Fax Number:
321-434-5419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 S APOLLO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-1969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-434-7216
Provider Business Practice Location Address Fax Number:
321-434-5419
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ESROCK
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP/CFO
Authorized Official Telephone Number:
321-434-5197

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162281800 . This is a "DEPARTMENT OF LABOR W/C" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2108505 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 152503 . This is a "STAYWELL/WELLCARE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1539717 . This is a "UMWA PROVIDER#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 490004803 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 67K . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 070375300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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