Provider Demographics
NPI:1659443042
Name:HALLANDALE OUTPATIENT SURGICAL CENTER,LTD
Entity Type:Organization
Organization Name:HALLANDALE OUTPATIENT SURGICAL CENTER,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-458-1689
Mailing Address - Street 1:306 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5527
Mailing Address - Country:US
Mailing Address - Phone:954-458-1689
Mailing Address - Fax:954-458-1699
Practice Address - Street 1:306 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5527
Practice Address - Country:US
Practice Address - Phone:954-458-1689
Practice Address - Fax:954-458-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1256261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113462800Medicaid
FL1256OtherSTATE LICENSE