Provider Demographics
NPI:1205937117
Name:PREMIUM SURGICAL SERVICES, L.L.C.
Entity type:Organization
Organization Name:PREMIUM SURGICAL SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE-TUDELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-2779
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:SUITE 729
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-559-2779
Mailing Address - Fax:305-559-6119
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:SUITE 729
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-559-2779
Practice Address - Fax:305-559-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZS0410X, 363AS0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty