Healthcare Provider Details

I. General information

NPI: 1295119675
Provider Name (Legal Business Name): EMBASSY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 S. PINE AVE.
OCALA FL
34471
US

IV. Provider business mailing address

11253 BRIDGEHOUSE RD
WINDERMERE FL
34786
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1919
  • 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: DR. VIJITHA REDDY
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 352-425-0501