Provider Demographics
NPI:1689636219
Name:FLORIDA OUTPATIENT SURGERY CENTER LTD
Entity Type:Organization
Organization Name:FLORIDA OUTPATIENT SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:180 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-830-0573
Mailing Address - Fax:407-830-4373
Practice Address - Street 1:180 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4706
Practice Address - Country:US
Practice Address - Phone:407-830-0573
Practice Address - Fax:407-830-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH12299261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079084200Medicaid
FLPH12299OtherSTATE LICENSE
FL079084200Medicaid