Healthcare Provider Details

I. General information

NPI: 1326877689
Provider Name (Legal Business Name): SURGICAL INSTITUTE OF CENTRAL FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12363 W COLONIAL DR STE 100
WINTER GARDEN FL
34787-4186
US

IV. Provider business mailing address

12363 W COLONIAL DR STE 100
WINTER GARDEN FL
34787-4186
US

V. Phone/Fax

Practice location:
  • Phone: 407-280-0887
  • Fax:
Mailing address:
  • Phone: 407-347-4044
  • Fax: 407-347-2799

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: PATRICK WIK
Title or Position: COO
Credential:
Phone: 407-347-4044