Provider Demographics
NPI:1447390604
Name:SOUTH FLORIDA SURGICAL GROUP
Entity Type:Organization
Organization Name:SOUTH FLORIDA SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-9522
Mailing Address - Street 1:8755 SW 94TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2407
Mailing Address - Country:US
Mailing Address - Phone:305-279-9522
Mailing Address - Fax:305-279-3218
Practice Address - Street 1:8755 SW 94TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2407
Practice Address - Country:US
Practice Address - Phone:305-279-9522
Practice Address - Fax:305-279-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040910174400000X
FLME0064414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF81696Medicare UPIN
FLD63984Medicare UPIN
FL39209Medicare ID - Type Unspecified