Provider Demographics
NPI:1902838402
Name:OUTPATIENT SURGERY CENTER, INC
Entity Type:Organization
Organization Name:OUTPATIENT SURGERY CENTER, INC
Other - Org Name:MARINER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-688-6393
Mailing Address - Street 1:5193 MARINER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1834
Mailing Address - Country:US
Mailing Address - Phone:352-688-6393
Mailing Address - Fax:352-688-1113
Practice Address - Street 1:5193 MARINER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1834
Practice Address - Country:US
Practice Address - Phone:352-688-6393
Practice Address - Fax:352-688-1113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTPATIENT SURGERY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1166261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1386Medicare PIN