Provider Demographics
NPI:1710327515
Name:SURGICALIST COMPANY LLC
Entity Type:Organization
Organization Name:SURGICALIST COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-624-3062
Mailing Address - Street 1:200 N JOHN YOUNG PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6601
Mailing Address - Country:US
Mailing Address - Phone:407-624-3062
Mailing Address - Fax:407-613-2223
Practice Address - Street 1:200 N JOHN YOUNG PKWY
Practice Address - Street 2:STE 203
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6601
Practice Address - Country:US
Practice Address - Phone:407-624-3062
Practice Address - Fax:407-613-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHK627AMedicare PIN