Provider Demographics
NPI:1013309459
Name:MELBOURNE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MELBOURNE SURGERY CENTER, LLC
Other - Org Name:MELBOURNE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:95 BULLDOG BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3332
Mailing Address - Country:US
Mailing Address - Phone:321-952-9800
Mailing Address - Fax:
Practice Address - Street 1:95 BULLDOG BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3332
Practice Address - Country:US
Practice Address - Phone:321-952-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical