Provider Demographics
NPI:1164656740
Name:SURGERY CENTER OF MOUNT DORA, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF MOUNT DORA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:USON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-383-1268
Mailing Address - Street 1:3710 LAKE CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757
Mailing Address - Country:US
Mailing Address - Phone:352-383-1268
Mailing Address - Fax:352-385-3199
Practice Address - Street 1:3710 LAKE CENTER DR.
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-383-1268
Practice Address - Fax:352-385-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical