Provider Demographics
NPI:1265031033
Name:LEVEL 4 SURGICAL LLC
Entity Type:Organization
Organization Name:LEVEL 4 SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VARIVODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-298-4335
Mailing Address - Street 1:50 SW 6TH AVE APT 603
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-4784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 SW 6TH AVE APT 603
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-4784
Practice Address - Country:US
Practice Address - Phone:786-298-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty