Provider Demographics
NPI:1275879132
Name:PREMIERCARE SURGERY CENTER OF KENDALL, LLC
Entity Type:Organization
Organization Name:PREMIERCARE SURGERY CENTER OF KENDALL, LLC
Other - Org Name:SURGERY CENTER OF WEST KENDALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-485-7657
Mailing Address - Street 1:11801 SW 90TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2182
Mailing Address - Country:US
Mailing Address - Phone:772-485-7657
Mailing Address - Fax:
Practice Address - Street 1:11801 SW 90TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2182
Practice Address - Country:US
Practice Address - Phone:772-485-7657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical