Provider Demographics
NPI:1891750980
Name:AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP
Other - Org Name:MEMORIAL SAME DAY SURGERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-962-3210
Mailing Address - Street 1:501 N FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1016
Mailing Address - Country:US
Mailing Address - Phone:954-430-1700
Mailing Address - Fax:954-450-7631
Practice Address - Street 1:501 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1016
Practice Address - Country:US
Practice Address - Phone:954-430-1700
Practice Address - Fax:954-450-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL917261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062943000Medicaid
FLF1249Medicare PIN
FLF1001Medicare PIN