Provider Demographics
NPI:1063473817
Name:CENTRAL HERNANDO SURGICAL ASSOCIATES P A
Entity Type:Organization
Organization Name:CENTRAL HERNANDO SURGICAL ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-592-7700
Mailing Address - Street 1:11333 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5404
Mailing Address - Country:US
Mailing Address - Phone:352-592-7700
Mailing Address - Fax:352-592-7734
Practice Address - Street 1:11333 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6311
Practice Address - Country:US
Practice Address - Phone:352-592-7700
Practice Address - Fax:352-592-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1856854OtherFIRSTHEALTH
FL228681OtherSTAYWELL/WELLCARE AND KID
FL5472963OtherCCN
FL7186654OtherAETNA
FL268130700Medicaid
FLH2279Medicare UPIN
FL268130700Medicaid