Provider Demographics
NPI:1437450798
Name:NAWADA AMBULATORY SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:NAWADA AMBULATORY SURGICAL CENTER LLC
Other - Org Name:NAWADA PLASTIC AND COSMETIC SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANNAKESHAVA
Authorized Official - Middle Name:U
Authorized Official - Last Name:NAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-293-2924
Mailing Address - Street 1:1121 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3902
Mailing Address - Country:US
Mailing Address - Phone:863-293-2924
Mailing Address - Fax:863-294-3450
Practice Address - Street 1:1121 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3902
Practice Address - Country:US
Practice Address - Phone:863-293-2924
Practice Address - Fax:863-294-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29078261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD86006Medicare UPIN