Provider Demographics
NPI:1114201647
Name:SURGICAL ASSOCIATES OF VOLUSIA
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF VOLUSIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-0250
Mailing Address - Street 1:1890 LPGA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7130
Mailing Address - Country:US
Mailing Address - Phone:386-274-0250
Mailing Address - Fax:386-274-0269
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-274-0250
Practice Address - Fax:386-274-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty