Provider Demographics
NPI:1952354326
Name:CENTER OF SURGICAL EXCELLENCE OF VENICE FLORIDA LLC
Entity Type:Organization
Organization Name:CENTER OF SURGICAL EXCELLENCE OF VENICE FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAFFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-412-2100
Mailing Address - Street 1:8421 POINTE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2232
Mailing Address - Country:US
Mailing Address - Phone:941-412-2100
Mailing Address - Fax:941-412-2160
Practice Address - Street 1:8421 POINTE LOOP DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2232
Practice Address - Country:US
Practice Address - Phone:941-270-2744
Practice Address - Fax:941-412-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL990010084736261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical