Provider Demographics
NPI:1578515995
Name:RAND SURGICAL PAVILLION CORP
Entity Type:Organization
Organization Name:RAND SURGICAL PAVILLION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-782-1700
Mailing Address - Street 1:5 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3542
Mailing Address - Country:US
Mailing Address - Phone:954-782-1700
Mailing Address - Fax:954-782-3432
Practice Address - Street 1:5 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3542
Practice Address - Country:US
Practice Address - Phone:954-782-1700
Practice Address - Fax:954-782-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL794261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1147Medicare ID - Type UnspecifiedRSP