Healthcare Provider Details

I. General information

NPI: 1760627830
Provider Name (Legal Business Name): MUSCULOSKELETAL AMBULATORY SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 WORTH CT
BRADENTON FL
34211-2110
US

IV. Provider business mailing address

6015 POINTE WEST BLVD
BRADENTON FL
34209-5532
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-0101
  • Fax:
Mailing address:
  • Phone: 941-782-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1314
License Number StateFL

VIII. Authorized Official

Name: MR. PAUL M DUCK
Title or Position: CEO
Credential:
Phone: 941-792-1404