Provider Demographics
NPI:1912952144
Name:MERRITT ISLAND ASC LLC
Entity Type:Organization
Organization Name:MERRITT ISLAND ASC LLC
Other - Org Name:COURTENAY SAME DAY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-630-3277
Mailing Address - Street 1:2400 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4127
Mailing Address - Country:US
Mailing Address - Phone:321-454-4007
Mailing Address - Fax:321-576-0257
Practice Address - Street 1:2400 N COURTENAY PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4127
Practice Address - Country:US
Practice Address - Phone:321-454-4007
Practice Address - Fax:321-576-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1249261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1249OtherSTATE ASC LICENSE
FL1249OtherSTATE ASC LICENSE