Provider Demographics
NPI:1821233925
Name:MELBOURNE ASC LP
Entity Type:Organization
Organization Name:MELBOURNE ASC LP
Other - Org Name:THE SURGERY CENTER OF MELBOURNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1401 S APOLLO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3179
Mailing Address - Country:US
Mailing Address - Phone:321-725-5151
Mailing Address - Fax:321-725-5157
Practice Address - Street 1:1401 S APOLLO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3179
Practice Address - Country:US
Practice Address - Phone:321-725-5151
Practice Address - Fax:321-725-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL023986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1063YMedicare PIN
FLK4762Medicare PIN
FLE1063XMedicare PIN