Provider Demographics
NPI:1043413727
Name:SURGICAL SERVICES OF FLORIDA INC
Entity Type:Organization
Organization Name:SURGICAL SERVICES OF FLORIDA INC
Other - Org Name:CARLOS A. BLANCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-761-9392
Mailing Address - Street 1:PO BOX 527432
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33152-7432
Mailing Address - Country:US
Mailing Address - Phone:305-761-9392
Mailing Address - Fax:305-381-0548
Practice Address - Street 1:11341 NW 42ND TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1810
Practice Address - Country:US
Practice Address - Phone:305-761-9392
Practice Address - Fax:305-381-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 71266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250957100Medicaid
FL1699716670OtherINDIVIDUAL NPI
FL266547600Medicaid
FL266547600Medicaid