Provider Demographics
NPI:1982268322
Name:SURGERY CENTER ON 27 LLC
Entity Type:Organization
Organization Name:SURGERY CENTER ON 27 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTHERINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-253-7928
Mailing Address - Street 1:4759 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7405 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1030
Practice Address - Country:US
Practice Address - Phone:863-658-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical