Healthcare Provider Details

I. General information

NPI: 1881736734
Provider Name (Legal Business Name): MILLENIA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 VINELAND RD SUITE 150
ORLANDO FL
32811-7300
US

IV. Provider business mailing address

4901 VINELAND RD SUITE 150
ORLANDO FL
32811-7300
US

V. Phone/Fax

Practice location:
  • Phone: 866-631-7890
  • Fax: 407-370-3028
Mailing address:
  • Phone: 866-631-7890
  • Fax: 407-370-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1212
License Number StateFL

VIII. Authorized Official

Name: MS. JENNIFER B BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954