Healthcare Provider Details

I. General information

NPI: 1013738152
Provider Name (Legal Business Name): NASA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 W NASA BLVD
MELBOURNE FL
32904-2346
US

IV. Provider business mailing address

1995 W NASA BLVD
MELBOURNE FL
32904-2346
US

V. Phone/Fax

Practice location:
  • Phone: 321-863-6985
  • Fax:
Mailing address:
  • Phone: 321-863-6985
  • Fax:

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: DEEP PATEL
Title or Position: CFO
Credential:
Phone: 321-863-6985