Provider Demographics
NPI:1578188983
Name:MIAMI BEACH SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MIAMI BEACH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-742-7985
Mailing Address - Street 1:400 W 41ST ST STE 512
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3517
Mailing Address - Country:US
Mailing Address - Phone:305-405-6910
Mailing Address - Fax:305-405-6912
Practice Address - Street 1:400 W 41ST ST STE 512
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3517
Practice Address - Country:US
Practice Address - Phone:305-405-6910
Practice Address - Fax:305-405-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578188983OtherOUT OF NETWORK PROVIDER