Healthcare Provider Details

I. General information

NPI: 1215924899
Provider Name (Legal Business Name): ATLANTIC SURGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW 12TH AVE SUITE 201
POMPANO BEACH FL
33069-3298
US

IV. Provider business mailing address

150 SW 12TH AVE SUITE 450
POMPANO BEACH FL
33069-3298
US

V. Phone/Fax

Practice location:
  • Phone: 954-946-3603
  • Fax: 954-781-2144
Mailing address:
  • Phone: 954-946-3603
  • Fax: 954-781-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1015
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN W. BEEBE
Title or Position: CEO
Credential:
Phone: 954-946-3603