Healthcare Provider Details

I. General information

NPI: 1518264332
Provider Name (Legal Business Name): SANTA FE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 COUNTY ROAD 466 SUITE 101
LADY LAKES FL
32162
US

IV. Provider business mailing address

8564 E COUNTY ROAD 466 SUITE 101
LADY LAKE FL
32162-3020
US

V. Phone/Fax

Practice location:
  • Phone: 407-256-0933
  • Fax: 407-774-0681
Mailing address:
  • Phone: 407-256-0933
  • Fax: 407-774-0681

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: NANCY K KASTNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-256-0933