Provider Demographics
NPI:1063495257
Name:DOCTORS SURGICAL PARTNERSHIP LLC
Entity Type:Organization
Organization Name:DOCTORS SURGICAL PARTNERSHIP LLC
Other - Org Name:MELBOURNE SAME DAY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ESROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-434-5197
Mailing Address - Street 1:PO BOX 562750
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-2750
Mailing Address - Country:US
Mailing Address - Phone:321-434-5491
Mailing Address - Fax:321-434-5419
Practice Address - Street 1:1035 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1969
Practice Address - Country:US
Practice Address - Phone:321-434-7216
Practice Address - Fax:321-434-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1086261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL162281800OtherDEPARTMENT OF LABOR W/C
FL2108505OtherAETNA PROVIDER #
FL152503OtherSTAYWELL/WELLCARE #
FL1539717OtherUMWA PROVIDER#
FL490004803OtherRAILROAD MEDICARE PROVIDE
FL67KOtherBLUE CROSS PROVIDER NUMBE
FL070375300Medicaid
FLF1313Medicare PIN