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General NPI Number Information
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NPI Number | 1710071519
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Entity Type | Organization
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Legal Business Name | BRANDON AMBULATORY SURGERY CENTER LC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 514 EICHENFELD DRIVE
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-571-7088
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Fax | 813-571-7099
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Provider Business Mailing Address
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Address Line | 514 EICHENFELD DRIVE
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-571-7088
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Fax | 813-571-7099
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | PAULA RUSSO
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Credential |
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Telephone | 813-571-7088
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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 |
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