Healthcare Provider Details

I. General information

NPI: 1396011714
Provider Name (Legal Business Name): MELBOURNE SURGICAL SERVICES, LL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OCALA RD STE 300
TALLAHASSEE FL
32304-1670
US

IV. Provider business mailing address

6339 E SPEEDWAY BLVD STE 201
TUCSON AZ
85710-1147
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-4130
  • Fax: 520-258-0304
Mailing address:
  • Phone: 520-547-4130
  • Fax: 520-258-0304

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: MS. ANNETTE FISCHER
Title or Position: MEDICAL BILLING
Credential:
Phone: 520-547-4130