Provider Demographics
NPI:1053851162
Name:SPECIALTY SURGERY CENTER OF FLORIDA, LLC
Entity Type:Organization
Organization Name:SPECIALTY SURGERY CENTER OF FLORIDA, LLC
Other - Org Name:ALLIANCE SPECIALTY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-274-2977
Mailing Address - Street 1:1671 N CLYDE MORRIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5590
Mailing Address - Country:US
Mailing Address - Phone:386-274-2977
Mailing Address - Fax:386-274-2362
Practice Address - Street 1:1545 HAND AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1139
Practice Address - Country:US
Practice Address - Phone:386-274-2977
Practice Address - Fax:386-274-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical