Provider Demographics
NPI:1134781263
Name:SURGICLEAR
Entity type:Organization
Organization Name:SURGICLEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOENSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-347-6771
Mailing Address - Street 1:1011 IVES DAIRY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2536
Mailing Address - Country:US
Mailing Address - Phone:954-347-6771
Mailing Address - Fax:954-347-6774
Practice Address - Street 1:1011 IVES DAIRY RD STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2536
Practice Address - Country:US
Practice Address - Phone:954-347-6771
Practice Address - Fax:954-347-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1011OtherSELF PAY