Provider Demographics
NPI:1952071920
Name:LAKEVIEW SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LAKEVIEW SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:DIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-277-2376
Mailing Address - Street 1:7448 DOCS GROVE CIR STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8010
Mailing Address - Country:US
Mailing Address - Phone:321-277-2376
Mailing Address - Fax:
Practice Address - Street 1:7448 DOCS GROVE CIR STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:321-277-2376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical