Provider Demographics
NPI:1558372029
Name:HOLIDAY SURGERY CENTER LIMITED PARTNERSHIP L L P
Entity Type:Organization
Organization Name:HOLIDAY SURGERY CENTER LIMITED PARTNERSHIP L L P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-934-5705
Mailing Address - Street 1:1109 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-5638
Mailing Address - Country:US
Mailing Address - Phone:727-934-5705
Mailing Address - Fax:727-937-3756
Practice Address - Street 1:1109 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5638
Practice Address - Country:US
Practice Address - Phone:727-934-5705
Practice Address - Fax:727-937-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL802261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079128800Medicaid
FLF1084Medicare PIN