1891750980 NPI number — AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP

Table of content: (NPI 1891750980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891750980 NPI number — AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP
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:
6
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:
1891750980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N FLAMINGO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33028-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-430-1700
Provider Business Mailing Address Fax Number:
954-450-7631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N FLAMINGO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33028-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-430-1700
Provider Business Practice Location Address Fax Number:
954-450-7631
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FITZSIMMONS
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
954-962-3210

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  917 , 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: 062943000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023008600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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