MEDICARE: SURGICAL INSTITUTE OF CENTRAL FLORIDA LLC

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

General Provider Information

NPI Number	:	1326877689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL INSTITUTE OF CENTRAL FLORIDA LLC

Provider Business Mailing Address
First Line	:	12363 W COLONIAL DR STE 100
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4186
Country	:	US
Telephone Number	:	407-347-4044
Fax Number	:	407-347-2799

Provider Business Practice Location Address
First Line	:	12363 W COLONIAL DR STE 100
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4186
Country	:	US
Telephone Number	:	407-347-4044
Fax Number	:	407-347-2799

Authorized Official
Title or Position	:	COO
Name	:	PATRICK WIK
Credential	:
Telephone Number	:	407-347-4044

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	03/25/2026

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