Healthcare Provider Details

I. General information

NPI: 1053851162
Provider Name (Legal Business Name): SPECIALTY SURGERY CENTER OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HAND AVE BUILDING A
ORMOND BEACH FL
32174-1139
US

IV. Provider business mailing address

1671 N CLYDE MORRIS BLVD STE 100
DAYTONA BEACH FL
32117-5590
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-2977
  • Fax: 386-274-2997
Mailing address:
  • Phone: 386-274-2977
  • Fax: 386-274-2362

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: VINOD MALIK
Title or Position: DIRECTOR
Credential: MD
Phone: 386-274-2977