Provider Demographics
NPI:1326045014
Name:GROVE PLACE SURGERY CENTER ,LLC
Entity Type:Organization
Organization Name:GROVE PLACE SURGERY CENTER ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:CONDIT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-778-3113
Mailing Address - Street 1:1325 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6599
Mailing Address - Country:US
Mailing Address - Phone:772-778-3113
Mailing Address - Fax:772-778-3116
Practice Address - Street 1:1325 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6599
Practice Address - Country:US
Practice Address - Phone:772-778-3113
Practice Address - Fax:772-778-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1167261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6C8OtherBCBS OF FL
FL=========OtherALL OTHER INS COMPANIES
FL=========OtherALL OTHER INS COMPANIES