Provider Demographics
NPI:1740771708
Name:EAST FORT LAUDERDALE ASC LLC
Entity Type:Organization
Organization Name:EAST FORT LAUDERDALE ASC LLC
Other - Org Name:FT. LAUDERDALE HEART & RHYTHM SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-644-8900
Mailing Address - Street 1:DEPT #6032
Mailing Address - Street 2:PO BOX 4417
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4417
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:610-537-6059
Practice Address - Street 1:1925 NE 45TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5158
Practice Address - Country:US
Practice Address - Phone:954-651-9847
Practice Address - Fax:954-990-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical