Healthcare Provider Details

I. General information

NPI: 1407335458
Provider Name (Legal Business Name): MERRITT ISLAND OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E MERRITT ISLAND CSWY STE 400
MERRITT ISLAND FL
32952
US

IV. Provider business mailing address

PO BOX 628771
ORLANDO FL
32862-8771
US

V. Phone/Fax

Practice location:
  • Phone: 321-735-6221
  • Fax: 813-864-4436
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 Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TRACIE GARI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 813-549-2134