MEDICARE: IQUEST SURGERY CENTER ,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	ME#92151	FL

General Provider Information

NPI Number	:	1215105275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IQUEST SURGERY CENTER ,INC

Provider Business Mailing Address
First Line	:	1251 W 44TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3331
Country	:	US
Telephone Number	:	305-819-8841
Fax Number	:	305-819-8841

Provider Business Practice Location Address
First Line	:	1251 W 44TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3331
Country	:	US
Telephone Number	:	305-819-8841
Fax Number	:	305-819-8841

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. IVAN CORO
Credential	:
Telephone Number	:	305-819-8841

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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