Healthcare Provider Details

I. General information

NPI: 1255298089
Provider Name (Legal Business Name): CORAL SPRINGS CHILDREN'S SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8977 S 1300 #475
WEST JORDAN UT
84088
US

IV. Provider business mailing address

8977 S 1300 #475
WEST JORDAN UT
84088
US

V. Phone/Fax

Practice location:
  • Phone: 301-494-3000
  • Fax:
Mailing address:
  • Phone: 301-494-3000
  • Fax:

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: JEFFREY WHEELER
Title or Position: CEO
Credential:
Phone: 301-494-3000