Provider Demographics
NPI:1760627830
Name:MUSCULOSKELETAL AMBULATORY SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:MUSCULOSKELETAL AMBULATORY SURGERY CENTER, INC.
Other - Org Name:THE SURGERY CENTER AT POINTE WEST - EAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-792-1404
Mailing Address - Street 1:6015 POINTE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5532
Mailing Address - Country:US
Mailing Address - Phone:941-782-0101
Mailing Address - Fax:
Practice Address - Street 1:1917 WORTH CT
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-2110
Practice Address - Country:US
Practice Address - Phone:941-782-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSCULOSKELETAL AMBULATORY SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1314261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075448000Medicaid
FL6AAOtherBCBS OF FL
FLF1529Medicare PIN