Healthcare Provider Details

I. General information

NPI: 1205657954
Provider Name (Legal Business Name): REMAGIN OFFICE SURGERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 THE GROVE DR STE 230
WINDERMERE FL
34786-8425
US

IV. Provider business mailing address

4750 THE GROVE DR STE 230
WINDERMERE FL
34786-8425
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-3937
  • Fax:
Mailing address:
  • Phone: 407-704-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KESHINI PARBHU
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 407-704-3937