Provider Demographics
NPI:1407501893
Name:SOUTH FLORIDA SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHACHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-755-0111
Mailing Address - Street 1:3001 CORAL HILLS DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4172
Mailing Address - Country:US
Mailing Address - Phone:954-755-0111
Mailing Address - Fax:954-755-0243
Practice Address - Street 1:3140 NW MEDICAL CENTER LN STE 120
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4735
Practice Address - Country:US
Practice Address - Phone:386-755-6796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty