Provider Demographics
NPI:1881791341
Name:SURGICAL SERVICE OF DADE COUNTY CORP
Entity type:Organization
Organization Name:SURGICAL SERVICE OF DADE COUNTY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-458-9895
Mailing Address - Street 1:1165 W 49TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3373
Mailing Address - Country:US
Mailing Address - Phone:305-512-5480
Mailing Address - Fax:305-512-5489
Practice Address - Street 1:1165 W 49TH ST STE 208
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3373
Practice Address - Country:US
Practice Address - Phone:305-512-5480
Practice Address - Fax:305-512-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26194CMedicare ID - Type UnspecifiedGENERAL PRACTICE
FLF95237Medicare UPIN