Provider Demographics
NPI:1518373695
Name:HOLLYWOOD SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:HOLLYWOOD SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAR-NAVON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-403-3991
Mailing Address - Street 1:1062 JANS PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6972
Mailing Address - Country:US
Mailing Address - Phone:321-403-3991
Mailing Address - Fax:321-978-0272
Practice Address - Street 1:1201 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:321-403-3991
Practice Address - Fax:321-978-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical