Healthcare Provider Details

I. General information

NPI: 1558323956
Provider Name (Legal Business Name): MELBOURNE SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 MEDICAL PARK DR SUITE 101
MELBOURNE FL
32901-3246
US

IV. Provider business mailing address

1340 MEDICAL PARK DR SUITE 101
MELBOURNE FL
32901-3246
US

V. Phone/Fax

Practice location:
  • Phone: 321-729-9493
  • 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

VIII. Authorized Official

Name: RICHARD L SHARFF JR.
Title or Position: VICE PRESIDENT/SECRETARY
Credential:
Phone: 205-545-2572