Healthcare Provider Details

I. General information

NPI: 1821655259
Provider Name (Legal Business Name): VOLUSIA CENTER FOR SURGICAL EXCELLENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/17/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N RIDGEWOOD AVE
EDGEWATER FL
32132-1617
US

IV. Provider business mailing address

303 N RIDGEWOOD AVE
EDGEWATER FL
32132-1617
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-1422
  • Fax: 386-424-1401
Mailing address:
  • Phone: 386-424-1422
  • Fax: 386-424-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OREST KRAJNYK
Title or Position: MANAGER
Credential: MD
Phone: 386-424-1422