Provider Demographics
NPI:1265484851
Name:VERO BEACH SURGERY CENTER LLC
Entity Type:Organization
Organization Name:VERO BEACH SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HUSSAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-778-0600
Mailing Address - Street 1:PO BOX 643408
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32964-3408
Mailing Address - Country:US
Mailing Address - Phone:772-778-0600
Mailing Address - Fax:772-778-4005
Practice Address - Street 1:845 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6564
Practice Address - Country:US
Practice Address - Phone:772-778-0600
Practice Address - Fax:772-778-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1121261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69LOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL490005126OtherRAILROAD MEDICARE
FL490005126OtherRAILROAD MEDICARE