Provider Demographics
NPI:1306866173
Name:PARK PLACE SURGERY CENTER L L C
Entity Type:Organization
Organization Name:PARK PLACE SURGERY CENTER L L C
Other - Org Name:PARK PLACE SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-569-6500
Mailing Address - Street 1:2450 MAITLAND CENTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4140
Mailing Address - Country:US
Mailing Address - Phone:407-875-0296
Mailing Address - Fax:407-875-0929
Practice Address - Street 1:2450 MAITLAND CENTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4140
Practice Address - Country:US
Practice Address - Phone:407-875-0296
Practice Address - Fax:407-875-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1208261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1430Medicare ID - Type UnspecifiedMCR PROVIDER NUMBER