Healthcare Provider Details

I. General information

NPI: 1821277153
Provider Name (Legal Business Name): SURGERY ASSISTANTS OF ORLANDO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 MEADOWMOUSE ST
ORLANDO FL
32837-7414
US

IV. Provider business mailing address

PO BOX 691418
ORLANDO FL
32869-1418
US

V. Phone/Fax

Practice location:
  • Phone: 407-810-7968
  • Fax: 407-240-7681
Mailing address:
  • Phone: 407-810-7968
  • Fax: 407-240-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateFM

VIII. Authorized Official

Name: ROCHE CAMPBELL
Title or Position: PRESIDENT
Credential: SFA
Phone: 407-810-7968