Provider Demographics
NPI:1174594584
Name:SHERIDAN SURGERY CENTER
Entity type:Organization
Organization Name:SHERIDAN SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-676-1870
Mailing Address - Street 1:95 BULLDOG BLVD
Mailing Address - Street 2:STE104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3332
Mailing Address - Country:US
Mailing Address - Phone:321-952-9800
Mailing Address - Fax:321-952-7889
Practice Address - Street 1:95 BULLDOG BLVD
Practice Address - Street 2:STE104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3332
Practice Address - Country:US
Practice Address - Phone:321-952-9800
Practice Address - Fax:321-952-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL846261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079177600Medicaid
FL490003969OtherRAILROAD MEDICARE
FL62YOtherBLUE CROSS BLUE SHIELD
FL62YOtherBLUE CROSS BLUE SHIELD