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General NPI Number Information
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NPI Number | 1164381216
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Entity Type | Organization
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Legal Business Name | VALLEYGATE SURGERY CENTER ORLANDO LLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 1405 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-2154
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Country | US
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Telephone | 910-485-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 LITHO PL
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | STRATEGIC DEVELOPMENT
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Name | ERICA KENNERSON
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Credential |
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Telephone | 910-485-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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