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
StateLicense IDTaxonomies
FL1306261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical