Provider Demographics
NPI:1235165531
Name:LAKE SURGERY & ENDOSCOPY CENTER LTD
Entity Type:Organization
Organization Name:LAKE SURGERY & ENDOSCOPY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-323-8868
Mailing Address - Street 1:8110 CNTY RD 44
Mailing Address - Street 2:8110 COUNTY ROAD 44, LEG A
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3704
Mailing Address - Country:US
Mailing Address - Phone:352-323-8868
Mailing Address - Fax:352-728-5497
Practice Address - Street 1:8110 COUNTY ROAD 44 LEG A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3704
Practice Address - Country:US
Practice Address - Phone:352-323-8868
Practice Address - Fax:352-323-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL845261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1244Medicare ID - Type Unspecified