Healthcare Provider Details

I. General information

NPI: 1659540524
Provider Name (Legal Business Name): OCALA HEALTH SURGICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SW 46TH CT SUITE 250
OCALA FL
34474-5708
US

IV. Provider business mailing address

4600 SW 46TH CT SUITE 250
OCALA FL
34474-5708
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-2400
  • Fax: 352-291-2405
Mailing address:
  • Phone: 352-291-2400
  • Fax: 352-291-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHUCK MEWSHAW
Title or Position: VP
Credential:
Phone: 850-521-2117