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General NPI Number Information
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NPI Number | 1407100480
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Entity Type | Organization
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Legal Business Name | SEACREST SURGICAL CENTER LLC
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 2314 S SEACREST BLVD SUITE 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-6788
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Country | US
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Telephone | 561-735-7766
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Fax | 561-732-2942
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Provider Business Mailing Address
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Address Line | 2314 S. SEACREST BLVD. SUITE 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33435
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Country | US
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Telephone | 561-735-7766
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Fax | 561-732-2942
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Authorized Official
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Title or Position | PRESIDENT-CEO
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Name | DR. KINGA EVA STYPEREK GROHMANN
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Credential | M.D.
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Telephone | 561-735-7766
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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 | FL
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