Provider Demographics
NPI:1568644490
Name:HARBOR CITY SURGICAL CARE
Entity Type:Organization
Organization Name:HARBOR CITY SURGICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-723-3500
Mailing Address - Street 1:211 E NEW HAVEN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4503
Mailing Address - Country:US
Mailing Address - Phone:321-723-3500
Mailing Address - Fax:321-723-1945
Practice Address - Street 1:211 E NEW HAVEN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4503
Practice Address - Country:US
Practice Address - Phone:321-723-3500
Practice Address - Fax:321-723-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical