Healthcare Provider Details

I. General information

NPI: 1578662227
Provider Name (Legal Business Name): PACE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 SUITE 120
PACE FL
32571-1096
US

IV. Provider business mailing address

3754 HIGHWAY 90 SUITE 120
PACE FL
32571-1096
US

V. Phone/Fax

Practice location:
  • Phone: 850-994-1883
  • Fax:
Mailing address:
  • Phone: 850-994-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. HENRY STOVALL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 850-416-7681