Provider Demographics
NPI:1205872108
Name:THE SURGERY & ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:THE SURGERY & ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-471-0786
Mailing Address - Street 1:3201 PHYSICIANS WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5447
Mailing Address - Country:US
Mailing Address - Phone:863-471-0786
Mailing Address - Fax:863-471-6834
Practice Address - Street 1:3201 PHYSICIANS WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5447
Practice Address - Country:US
Practice Address - Phone:863-471-0786
Practice Address - Fax:863-471-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1179261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6E4OtherBLUE CROSS BLUE SHIELD
FL075682200Medicaid
FLF1404Medicare ID - Type Unspecified