Provider Demographics
NPI:1679591515
Name:TWIN LAKES SURGERY CENTER
Entity Type:Organization
Organization Name:TWIN LAKES SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-3232
Mailing Address - Street 1:1890 LPGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7130
Mailing Address - Country:US
Mailing Address - Phone:386-274-3232
Mailing Address - Fax:386-274-1838
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-274-3232
Practice Address - Fax:386-274-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1207261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1426Medicare ID - Type Unspecified