Provider Demographics
NPI:1235567264
Name:WENTWORTH SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WENTWORTH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRONAWITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-330-3381
Mailing Address - Street 1:777 E ATLANTIC AVE STE 222
Mailing Address - Street 2:C/O HDA ENTERPRISES, INC.
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5352
Mailing Address - Country:US
Mailing Address - Phone:561-330-3381
Mailing Address - Fax:561-330-3382
Practice Address - Street 1:6 WORKS WAY
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878
Practice Address - Country:US
Practice Address - Phone:603-285-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical