Healthcare Provider Details

I. General information

NPI: 1891750980
Provider Name (Legal Business Name): AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N FLAMINGO RD
PEMBROKE PINES FL
33028-1016
US

IV. Provider business mailing address

501 N FLAMINGO RD
PEMBROKE PINES FL
33028-1016
US

V. Phone/Fax

Practice location:
  • Phone: 954-430-1700
  • Fax: 954-450-7631
Mailing address:
  • Phone: 954-430-1700
  • Fax: 954-450-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number917
License Number StateFL

VIII. Authorized Official

Name: MR. TOM FITZSIMMONS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 954-962-3210