Provider Demographics
NPI:1396214938
Name:GRACE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:GRACE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-351-0029
Mailing Address - Street 1:2301 SE 3RD AVE BLDG 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5105
Mailing Address - Country:US
Mailing Address - Phone:352-351-0029
Mailing Address - Fax:352-804-9977
Practice Address - Street 1:2301 SE 3RD AVE BLDG 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5105
Practice Address - Country:US
Practice Address - Phone:352-351-0029
Practice Address - Fax:352-804-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical