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General NPI Number Information
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NPI Number | 1497743389
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGERY CENTER, INC.
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10900 SE 174TH PLACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8984
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Country | US
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Telephone | 352-245-9562
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Fax | 352-245-9563
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Provider Business Mailing Address
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Address Line | 10900 SE 174TH PLACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8984
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Country | US
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Telephone | 352-245-9562
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Fax | 352-245-9563
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | RICHARD M. COWIN
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Credential | D.P.M.
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Telephone | 352-245-9562
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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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