Healthcare Provider Details

I. General information

NPI: 1215144191
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF OCALA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 SW 20TH PLACE BUILDING 100
OCALA FL
34471-7881
US

IV. Provider business mailing address

1920 SW 20TH PLACE BUILDING 100
OCALA FL
34471-7881
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-1212
  • Fax: 352-237-0066
Mailing address:
  • Phone: 352-237-1212
  • Fax: 352-237-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME59502
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME59502
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME59502
License Number StateFL

VIII. Authorized Official

Name: TERESA BARUP
Title or Position: BUSINES MANAGER
Credential:
Phone: 352-237-1212