Provider Demographics
NPI:1376689232
Name:SURGICAL ASSOCIATES OF VENICE AND ENGLEWOOD, PA
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF VENICE AND ENGLEWOOD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-484-7506
Mailing Address - Street 1:436 NOKOMIS AVE S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2617
Mailing Address - Country:US
Mailing Address - Phone:941-445-5054
Mailing Address - Fax:941-303-6796
Practice Address - Street 1:436 NOKOMIS AVE S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2617
Practice Address - Country:US
Practice Address - Phone:941-488-7742
Practice Address - Fax:941-484-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00778OtherBLUE CROSS BLUE SHIELD
FLCB1948OtherRAILROAD MEDICARE
FL=========OtherTAX IDENTIFICATION