Healthcare Provider Details

I. General information

NPI: 1548257892
Provider Name (Legal Business Name): UROLOGICAL AMBULATORY SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N MILLS AVE
ORLANDO FL
32803-1854
US

IV. Provider business mailing address

1812 N MILLS AVE
ORLANDO FL
32803-1854
US

V. Phone/Fax

Practice location:
  • Phone: 407-897-3499
  • Fax: 407-894-8746
Mailing address:
  • Phone: 407-897-3499
  • Fax: 407-894-8746

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: JEFFREY THILL
Title or Position: PARTNER
Credential: M.D.
Phone: 407-897-3499