Provider Demographics
NPI:1619049269
Name:OUTPATIENT SURGERY CENTER INC
Entity Type:Organization
Organization Name:OUTPATIENT SURGERY CENTER INC
Other - Org Name:BRANDON OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-731-0416
Mailing Address - Street 1:PO BOX 10390
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34603-0390
Mailing Address - Country:US
Mailing Address - Phone:352-688-6393
Mailing Address - Fax:352-688-1113
Practice Address - Street 1:201 NOLAND DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5728
Practice Address - Country:US
Practice Address - Phone:813-684-7246
Practice Address - Fax:302-688-1113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTPATIENT SURGERY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1157261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290429OtherSTAYWELLWELLCARE
FL002639517OtherUNITEDHEALTH
FL002639517OtherUNITEDHEALTH
FL=========OtherHUMANA