Provider Demographics
NPI:1033523394
Name:SURGICAL ASSISTANTS OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:SURGICAL ASSISTANTS OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-292-2156
Mailing Address - Street 1:1555 BOREN DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2989
Mailing Address - Country:US
Mailing Address - Phone:407-292-2156
Mailing Address - Fax:407-241-2868
Practice Address - Street 1:1555 BOREN DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2989
Practice Address - Country:US
Practice Address - Phone:407-292-2156
Practice Address - Fax:407-241-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBB011Medicare PIN