Provider Demographics
NPI:1093110850
Name:GLOBAL MICROSURGICAL CENTER OF PARK CITY,LLC
Entity Type:Organization
Organization Name:GLOBAL MICROSURGICAL CENTER OF PARK CITY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-718-5549
Mailing Address - Street 1:2706 REW CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4215
Mailing Address - Country:US
Mailing Address - Phone:407-718-5549
Mailing Address - Fax:407-264-8969
Practice Address - Street 1:1820 SIDEWINDER DR STE 200
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7563
Practice Address - Country:US
Practice Address - Phone:407-718-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical