Provider Demographics
NPI:1750169975
Name:UNOVA ASC, INC
Entity type:Organization
Organization Name:UNOVA ASC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MANDUME
Authorized Official - Last Name:KERINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-973-6799
Mailing Address - Street 1:539 ROLLING ACRES ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-561-8827
Mailing Address - Fax:353-561-8912
Practice Address - Street 1:539 ROLLING ACRES ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-561-8827
Practice Address - Fax:353-561-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical