Provider Demographics
NPI:1689604886
Name:SOUTH COUNTY OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH COUNTY OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROTHCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-2811
Mailing Address - Street 1:16244 MILITARY TRL
Mailing Address - Street 2:SUITE 670
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:561-637-5808
Mailing Address - Fax:561-637-5848
Practice Address - Street 1:16244 MILITARY TRL
Practice Address - Street 2:SUITE 670
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-637-5808
Practice Address - Fax:561-637-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00359237OtherMEDICARE RAILROAD
FL0767140 00Medicaid
FL=========OtherTAX ID
FLP00359237OtherMEDICARE RAILROAD