Provider Demographics
NPI:1376779561
Name:SURGICARE OF MIRAMAR LLC
Entity Type:Organization
Organization Name:SURGICARE OF MIRAMAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:14601 SW 29TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4712
Mailing Address - Country:US
Mailing Address - Phone:954-266-3801
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 29TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4712
Practice Address - Country:US
Practice Address - Phone:954-266-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical