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General NPI Number Information
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NPI Number | 1306866173
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Entity Type | Organization
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Legal Business Name | PARK PLACE SURGERY CENTER L L C
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 2450 MAITLAND CENTER PKWY SUITE 100
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City | MAITLAND
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State | FL
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Zip | 32751-4140
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Country | US
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Telephone | 407-875-0296
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Fax | 407-875-0929
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Provider Business Mailing Address
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Address Line | 2450 MAITLAND CENTER PKWY SUITE 100
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City | MAITLAND
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State | FL
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Zip | 32751-4140
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Country | US
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Telephone | 407-875-0296
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Fax | 407-875-0929
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Authorized Official
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Title or Position | PRESIDENT/COO
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Name | MR. MICHAEL DOYLE
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Credential |
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Telephone | 813-569-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 1208
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License Number State | FL
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