Provider Demographics
NPI:1912346677
Name:SURGICAL CENTER AT SUN N LAKE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:SURGICAL CENTER AT SUN N LAKE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ROS
Authorized Official - Last Name:CARRETERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-414-8131
Mailing Address - Street 1:2367 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4926
Mailing Address - Country:US
Mailing Address - Phone:863-414-8131
Mailing Address - Fax:863-402-5449
Practice Address - Street 1:2367 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4926
Practice Address - Country:US
Practice Address - Phone:863-414-8131
Practice Address - Fax:863-402-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty