Provider Demographics
NPI:1891876165
Name:OCALA NEUROSURGICAL CENTER PA
Entity Type:Organization
Organization Name:OCALA NEUROSURGICAL CENTER PA
Other - Org Name:OCALA NEUROSURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SURRENCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-622-3360
Mailing Address - Street 1:1901 SE 18TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8211
Mailing Address - Country:US
Mailing Address - Phone:352-622-3360
Mailing Address - Fax:352-629-4512
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-622-3360
Practice Address - Fax:352-629-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL161589500Medicaid
FL=========OtherTAX IDENTIFICATION NUMBER
FL6160850001Medicare NSC