Provider Demographics
NPI:1528553831
Name:ORLANDO SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ORLANDO SURGERY CENTER, LLC
Other - Org Name:ORLANDO SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:DIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:321-841-8199
Mailing Address - Street 1:65 STURTEVANT ST # MP162
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2016
Mailing Address - Country:US
Mailing Address - Phone:321-841-8199
Mailing Address - Fax:
Practice Address - Street 1:3435 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4049
Practice Address - Country:US
Practice Address - Phone:321-841-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical