Provider Demographics
NPI:1558323956
Name:MELBOURNE SURGERY CENTER LP
Entity Type:Organization
Organization Name:MELBOURNE SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:1340 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1340 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3246
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1256Medicare PIN