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General NPI Number Information
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NPI Number | 1750169975
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Entity Type | Organization
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Legal Business Name | UNOVA ASC, INC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 539 ROLLING ACRES ROAD SUITE D
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-561-8827
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Fax | 353-561-8912
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Provider Business Mailing Address
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Address Line | 539 ROLLING ACRES ROAD SUITE D
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-561-8827
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Fax | 353-561-8912
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. JEFFREY MANDUME KERINA
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Credential | MD
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Telephone | 352-973-6799
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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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