Provider Demographics
NPI:1982676227
Name:THE PALMETTO ASC, LLC
Entity Type:Organization
Organization Name:THE PALMETTO ASC, LLC
Other - Org Name:THE PALMETTO SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-8220
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-512-8220
Mailing Address - Fax:305-512-4945
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-512-8220
Practice Address - Fax:305-512-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1055261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109945200Medicaid
FL10-C0001287Medicare Oscar/Certification
FL079232200Medicaid
FLF1287Medicare PIN