Provider Demographics
NPI:1669803391
Name:SURGERY CENTER OF VIERA LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF VIERA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:DEUKMEDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-751-8700
Mailing Address - Street 1:7955 SPYGLASS HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8249
Mailing Address - Country:US
Mailing Address - Phone:321-751-8700
Mailing Address - Fax:321-775-1364
Practice Address - Street 1:7955 SPYGLASS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8249
Practice Address - Country:US
Practice Address - Phone:321-751-8700
Practice Address - Fax:321-775-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01410964OtherRAILROAD MCARE
FL6EROtherBCBSFL
FL5880893OtherAETNA
FLF1587Medicare PIN