Provider Demographics
NPI:1346662186
Name:NATIONAL SURGICAL CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:NATIONAL SURGICAL CENTERS OF AMERICA LLC
Other - Org Name:NSCOA PORT ST. LUCIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-622-5766
Mailing Address - Street 1:5365 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8172
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-241-9339
Practice Address - Street 1:150 SW CHAMBER CT.
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3413
Practice Address - Country:US
Practice Address - Phone:772-807-9000
Practice Address - Fax:772-807-9087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PAIN & REHABILITATION ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-14
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1372261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1592Medicare PIN