Healthcare Provider Details

I. General information

NPI: 1487840740
Provider Name (Legal Business Name): ORANGE CITY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 TOWN CENTER DR SUITE 100
ORANGE CITY FL
32763-8361
US

IV. Provider business mailing address

963 TOWN CENTER DR SUITE 100
ORANGE CITY FL
32763-8254
US

V. Phone/Fax

Practice location:
  • Phone: 866-631-7890
  • Fax:
Mailing address:
  • Phone: 866-631-7890
  • 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: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5900