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General NPI Number Information
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NPI Number | 1679591515
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Entity Type | Organization
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Legal Business Name | TWIN LAKES SURGERY CENTER
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1890 LPGA BLVD SUITE 200
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7130
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Country | US
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Telephone | 386-274-3232
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Fax | 386-274-1838
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Provider Business Mailing Address
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Address Line | 1890 LPGA BLVD SUITE 200
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7130
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Country | US
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Telephone | 386-274-3232
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Fax | 386-274-1838
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Authorized Official
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Title or Position | CODER
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Name | DEBBIE BOYER
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Credential |
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Telephone | 386-274-3232
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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 | 1207
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License Number State | FL
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