Provider Demographics
NPI:1578876298
Name:PERFORMANCE SURGICAL LLC
Entity Type:Organization
Organization Name:PERFORMANCE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCALETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-426-1169
Mailing Address - Street 1:721 SE 17TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2983
Mailing Address - Country:US
Mailing Address - Phone:954-765-3200
Mailing Address - Fax:
Practice Address - Street 1:721 SE 17TH ST STE 10
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2983
Practice Address - Country:US
Practice Address - Phone:954-765-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207LP2900X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty