Provider Demographics
NPI:1134366370
Name:CENTER OF SURGICAL EXCELLENCE
Entity type:Organization
Organization Name:CENTER OF SURGICAL EXCELLENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER GASTROENTEROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAFFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-412-9787
Mailing Address - Street 1:8421 POINTE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2232
Mailing Address - Country:US
Mailing Address - Phone:941-412-9787
Mailing Address - Fax:941-412-2160
Practice Address - Street 1:8421 POINTE LOOP DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2232
Practice Address - Country:US
Practice Address - Phone:941-412-9787
Practice Address - Fax:941-412-2160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER OF SURGICAL EXCELLENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
FL1269261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1488Medicare PIN