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General NPI Number Information
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NPI Number | 1740771708
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Entity Type | Organization
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Legal Business Name | EAST FORT LAUDERDALE ASC LLC
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 1925 NE 45TH ST STE 100
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-5158
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Country | US
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Telephone | 954-651-9847
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Fax | 954-990-6191
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Provider Business Mailing Address
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Address Line | DEPT #6032 PO BOX 4417
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City | HOUSTON
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State | TX
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Zip | 77210-4417
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Country | US
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Telephone | 610-644-8900
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Fax | 610-537-6059
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Authorized Official
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Title or Position | SR. VICE PRESIDENT
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Name | GREGG MILLER
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Credential | MD
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Telephone | 610-644-8900
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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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