Healthcare Provider Details

I. General information

NPI: 1538648613
Provider Name (Legal Business Name): VOLUSIA CENTER FOR SURGICAL EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568 S RIDGEWOOD AVE STE 4
EDGEWATER FL
32141
US

IV. Provider business mailing address

2568 S RIDGEWOOD AVE STE 4
EDGEWATER FL
32141-7535
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

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