Provider Demographics
NPI:1417190935
Name:MID-FLORIDA ENDOSCOPY & SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MID-FLORIDA ENDOSCOPY & SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THIMMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-861-8555
Mailing Address - Street 1:1950 SW 18TH CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7857
Mailing Address - Country:US
Mailing Address - Phone:352-861-8555
Mailing Address - Fax:352-401-0124
Practice Address - Street 1:1950 SW 18TH CT
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7857
Practice Address - Country:US
Practice Address - Phone:352-861-8555
Practice Address - Fax:352-401-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1327261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1547Medicare UPIN