Healthcare Provider Details

I. General information

NPI: 1720660806
Provider Name (Legal Business Name): PRECISION SURGICENTER OF SAINT CLOUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 200
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 200
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-2010
  • Fax: 407-891-8211
Mailing address:
  • Phone: 407-891-2010
  • Fax: 407-891-8211

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: MASSIEL MENA
Title or Position: CLINICAL DIRECTOR
Credential: MBA
Phone: 407-891-2010