Healthcare Provider Details

I. General information

NPI: 1750169975
Provider Name (Legal Business Name): UNOVA ASC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 ROLLING ACRES ROAD SUITE D
LADY LAKE FL
32159
US

IV. Provider business mailing address

539 ROLLING ACRES ROAD SUITE D
LADY LAKE FL
32159
US

V. Phone/Fax

Practice location:
  • Phone: 352-561-8827
  • Fax: 353-561-8912
Mailing address:
  • Phone: 352-561-8827
  • Fax: 353-561-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEFFREY MANDUME KERINA
Title or Position: SECRETARY
Credential: MD
Phone: 352-973-6799