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General NPI Number Information
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NPI Number | 1437450798
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Entity Type | Organization
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Legal Business Name | NAWADA AMBULATORY SURGICAL CENTER LLC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 1121 1ST ST S
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3902
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Country | US
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Telephone | 863-293-2924
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Fax | 863-294-3450
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Provider Business Mailing Address
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Address Line | 1121 1ST ST S
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3902
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Country | US
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Telephone | 863-293-2924
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Fax | 863-294-3450
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | DR. CHANNAKESHAVA U NAWADA
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Credential | M.D.
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Telephone | 863-293-2924
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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 | ME29078
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License Number State | FL
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