=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659507812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RINEHART SURGERY CENTER OF LAKE MARY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2009
-----------------------------------------------------
Last Update Date | 06/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 917 RINEHART RD 1001
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-708-5383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 917 RINEHART RD 1001
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-708-5383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. SUZAN M SATTLER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 781-820-6134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 1225
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------