Provider Demographics
NPI: | 1457502239 |
---|---|
Name: | APOLLO SURGERY CENTER LLC |
Entity Type: | Organization |
Organization Name: | APOLLO SURGERY CENTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MAGED |
Authorized Official - Middle Name: | DOSS |
Authorized Official - Last Name: | FARID |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 321-726-9393 |
Mailing Address - Street 1: | 375 S WICKHAM RD |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST MELBOURNE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32904-1135 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-726-9393 |
Mailing Address - Fax: | 321-726-9395 |
Practice Address - Street 1: | 375 S WICKHAM RD |
Practice Address - Street 2: | |
Practice Address - City: | WEST MELBOURNE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32904-1135 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-726-9393 |
Practice Address - Fax: | 321-726-9395 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-10-10 |
Last Update Date: | 2008-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 1306 | 261QA1903X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |