Healthcare Provider Details

I. General information

NPI: 1033523394
Provider Name (Legal Business Name): SURGICAL ASSISTANTS OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BOREN DR
OCOEE FL
34761-2989
US

IV. Provider business mailing address

1555 BOREN DR
OCOEE FL
34761-2989
US

V. Phone/Fax

Practice location:
  • Phone: 407-292-2156
  • Fax: 407-241-2868
Mailing address:
  • Phone: 407-292-2156
  • Fax: 407-241-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 407-292-2156