Provider Demographics
NPI:1568674281
Name:VILLAGES ENDOSCOPY & SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:VILLAGES ENDOSCOPY & SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LALBAHADUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGABHAIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-245-7427
Mailing Address - Street 1:10900 SE 174TH PLACE
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491
Mailing Address - Country:US
Mailing Address - Phone:352-245-7427
Mailing Address - Fax:352-245-2387
Practice Address - Street 1:10900 SE 174TH PLACE
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-245-7427
Practice Address - Fax:352-245-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1423Medicare PIN