Provider Demographics
NPI:1881736734
Name:MILLENIA SURGERY CENTER LLC
Entity type:Organization
Organization Name:MILLENIA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:4901 VINELAND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7300
Mailing Address - Country:US
Mailing Address - Phone:866-631-7890
Mailing Address - Fax:407-370-3028
Practice Address - Street 1:4901 VINELAND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7300
Practice Address - Country:US
Practice Address - Phone:866-631-7890
Practice Address - Fax:407-370-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1212261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076884700Medicaid