Provider Demographics
NPI:1922203769
Name:HYSONG SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:HYSONG SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:HYSONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-391-9200
Mailing Address - Street 1:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1569
Mailing Address - Country:US
Mailing Address - Phone:352-391-9200
Mailing Address - Fax:352-391-9204
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:SUITE 1830
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-391-9200
Practice Address - Fax:352-391-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85213208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62960Medicare ID - Type Unspecified
FLH75434Medicare UPIN
FLAD205Medicare PIN