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General NPI Number Information
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NPI Number | 1295258416
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Entity Type | Organization
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Legal Business Name | PUMPKIN PATCH AMBULATORY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 1500 S ORLANDO AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-5500
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Country | US
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Telephone | 407-740-0909
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Fax | 407-756-1605
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Provider Business Mailing Address
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Address Line | 1500 S ORLANDO AVE STE 100
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City | WINTER PARK
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State | FL
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Zip | 32789-5500
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Country | US
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Telephone | 407-740-0909
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Fax | 407-821-3489
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | RANDALL A LOY
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Credential | MD
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Telephone | 407-740-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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