Provider Demographics
NPI:1578740288
Name:SURGICAL ASSOCIATES OF MARION COUNTY PA
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MARION COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:OVERCASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-368-2828
Mailing Address - Street 1:150 SE 17TH STREET
Mailing Address - Street 2:SUITE 603
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5162
Mailing Address - Country:US
Mailing Address - Phone:352-368-2828
Mailing Address - Fax:352-368-7670
Practice Address - Street 1:150 SE 17TH STREET
Practice Address - Street 2:SUITE 603
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5162
Practice Address - Country:US
Practice Address - Phone:352-368-2828
Practice Address - Fax:352-368-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56492208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374619400Medicaid
FL374619400Medicaid
F45210Medicare UPIN