Provider Demographics
NPI:1235165556
Name:SURGICAL GROUP LLP
Entity Type:Organization
Organization Name:SURGICAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-504-1000
Mailing Address - Street 1:1007 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2833
Mailing Address - Country:US
Mailing Address - Phone:321-504-1000
Mailing Address - Fax:321-632-1099
Practice Address - Street 1:1007 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2833
Practice Address - Country:US
Practice Address - Phone:321-504-1000
Practice Address - Fax:321-632-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCD2994OtherRR MEDICARE
FLCD2994OtherRR MEDICARE