Provider Demographics
NPI:1700043585
Name:OSCEOLA SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:OSCEOLA SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-870-0808
Mailing Address - Street 1:900 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4117
Mailing Address - Country:US
Mailing Address - Phone:407-870-0808
Mailing Address - Fax:407-870-9128
Practice Address - Street 1:900 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4117
Practice Address - Country:US
Practice Address - Phone:407-870-0808
Practice Address - Fax:407-870-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty