Provider Demographics
NPI:1629182977
Name:SOUTHERN SURGICENTER
Entity type:Organization
Organization Name:SOUTHERN SURGICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CEDENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-0303
Mailing Address - Street 1:2213 PONCE BYP
Mailing Address - Street 2:EDIF PARRA SUITE 201
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1318
Mailing Address - Country:US
Mailing Address - Phone:787-841-0303
Mailing Address - Fax:
Practice Address - Street 1:2213 PONCE BYP
Practice Address - Street 2:EDIF PARRA SUITE 201
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-841-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30176OtherCRUZ AZUL
PR850011OtherMMM HEALTHCARE
PR18512OtherTRIPLE S
PR40124OtherPREFFERED MEDICARE CHOICE
PR5501148OtherACAA
PR30512OtherCFSE
PR70170OtherMCS
PR2873OtherINT MEDICAL CARD
PR5501148OtherACAA