Provider Demographics
NPI:1174503080
Name:THE SURGICAL CENTER FOR EXCELLENCE, LLLP
Entity Type:Organization
Organization Name:THE SURGICAL CENTER FOR EXCELLENCE, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-522-1930
Mailing Address - Street 1:202 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4454
Mailing Address - Country:US
Mailing Address - Phone:850-522-1930
Mailing Address - Fax:850-522-1940
Practice Address - Street 1:202 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4454
Practice Address - Country:US
Practice Address - Phone:850-522-1930
Practice Address - Fax:850-522-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1222261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075971600Medicaid
FL6K5OtherBLUE CROSS
FL075971600Medicaid