=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740413400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTIC SURGERY & LASER CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2009
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8040 N WICKHAM RD STE 101
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-8298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-757-7276
-----------------------------------------------------
Fax | 321-757-7211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8040 N WICKHAM RD STE 101
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-8298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-757-7276
-----------------------------------------------------
Fax | 321-757-7211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. JASON DARLINGTON
-----------------------------------------------------
Credential | M.D,
-----------------------------------------------------
Telephone | 321-757-7276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------