1396011714 NPI number — MELBOURNE SURGICAL SERVICES, LL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396011714 NPI number — MELBOURNE SURGICAL SERVICES, LL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELBOURNE SURGICAL SERVICES, LL
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:
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 Information

NPI Number:
1396011714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6339 E SPEEDWAY BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85710-1147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-547-4130
Provider Business Mailing Address Fax Number:
520-258-0304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OCALA RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32304-1670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-547-4130
Provider Business Practice Location Address Fax Number:
520-258-0304
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FISCHER
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLING
Authorized Official Telephone Number:
520-547-4130

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com