Provider Demographics
NPI:1821655259
Name:VOLUSIA CENTER FOR SURGICAL EXCELLENCE, LLC
Entity Type:Organization
Organization Name:VOLUSIA CENTER FOR SURGICAL EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OREST
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAJNYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-424-1422
Mailing Address - Street 1:303 N RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1617
Mailing Address - Country:US
Mailing Address - Phone:386-424-1422
Mailing Address - Fax:386-424-1401
Practice Address - Street 1:303 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1617
Practice Address - Country:US
Practice Address - Phone:386-424-1422
Practice Address - Fax:386-424-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty