Provider Demographics
NPI:1629262274
Name:THE SURGERY CENTER OF THE VILLAGES, LLC
Entity Type:Organization
Organization Name:THE SURGERY CENTER OF THE VILLAGES, LLC
Other - Org Name:THE SURGERY CENTER OF THE VILLAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-214-0144
Mailing Address - Street 1:17560 SE 109TH TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-6907
Mailing Address - Country:US
Mailing Address - Phone:352-735-2020
Mailing Address - Fax:352-347-1421
Practice Address - Street 1:17560 SE 109TH TERRACE RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-6907
Practice Address - Country:US
Practice Address - Phone:352-735-2020
Practice Address - Fax:352-347-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10C0001514Medicare Oscar/Certification
FLF1514Medicare PIN