Provider Demographics
NPI:1750313144
Name:AMBULATORY SURGICAL CARE, LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-453-3937
Mailing Address - Street 1:1045 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4531
Mailing Address - Country:US
Mailing Address - Phone:321-453-3937
Mailing Address - Fax:321-452-5404
Practice Address - Street 1:1045 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4531
Practice Address - Country:US
Practice Address - Phone:321-453-3937
Practice Address - Fax:321-452-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL849261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61LOtherBC/BS PROVIDER NUMBER
FL079072900Medicaid
FL=========OtherTIN
FLF1143Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER