Provider Demographics
NPI:1467783688
Name:PREMIER SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:PREMIER SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LALBAHADUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGABHAIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-636-6969
Mailing Address - Street 1:2060 N DONNELLY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2824
Mailing Address - Country:US
Mailing Address - Phone:352-383-7777
Mailing Address - Fax:352-383-8875
Practice Address - Street 1:2130 VINDALE RD.
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5637
Practice Address - Country:US
Practice Address - Phone:352-383-7777
Practice Address - Fax:352-383-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical