Provider Demographics
NPI:1417994856
Name:DELRAY AMBULATORY SURGICAL & LASER CENTER
Entity Type:Organization
Organization Name:DELRAY AMBULATORY SURGICAL & LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER DIR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-495-9111
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:BLDG B
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-495-9111
Mailing Address - Fax:561-495-6766
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:BLDG B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-495-9111
Practice Address - Fax:561-495-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL789261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1023388OtherCAREPLUS
FL64UOtherBC
FL1023388OtherCAREPLUS