Healthcare Provider Details

I. General information

NPI: 1942884457
Provider Name (Legal Business Name): CVI AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6547 SW STATE ROAD 200
OCALA FL
34476-5575
US

IV. Provider business mailing address

2111 SW 20TH PL
OCALA FL
34471-7734
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4251
  • Fax:
Mailing address:
  • Phone: 352-622-4251
  • 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: REY ESTEVAN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 352-622-4251