Provider Demographics
NPI:1336346246
Name:GARROVILLO SURGICAL CARE LLC
Entity Type:Organization
Organization Name:GARROVILLO SURGICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARROVILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-5216
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0130
Mailing Address - Country:US
Mailing Address - Phone:863-421-5216
Mailing Address - Fax:863-422-8476
Practice Address - Street 1:111 WEBB DR
Practice Address - Street 2:SUITE 3
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3944
Practice Address - Country:US
Practice Address - Phone:863-421-5216
Practice Address - Fax:863-422-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88733208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH90665Medicare UPIN
FLK8917Medicare ID - Type Unspecified