Provider Demographics
NPI:1669483137
Name:PHYSICIANS AMBULATORY SURGERY CENTER INC
Entity Type:Organization
Organization Name:PHYSICIANS AMBULATORY SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-672-1080
Mailing Address - Street 1:300 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5956
Mailing Address - Country:US
Mailing Address - Phone:386-672-1080
Mailing Address - Fax:386-672-8628
Practice Address - Street 1:300 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5956
Practice Address - Country:US
Practice Address - Phone:386-672-1080
Practice Address - Fax:386-672-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL886261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079155500Medicaid
FLF1202Medicare PIN