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General NPI Number Information
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NPI Number | 1811995137
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Entity Type | Organization
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Legal Business Name | RINEHART LAKE MARY SURGICAL CENTER
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 917 RINEHART RD SUITE 1001
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City | LAKE MARY
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State | FL
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Zip | 32746-4802
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Country | US
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Telephone | 407-708-5383
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Fax | 407-708-5396
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Provider Business Mailing Address
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Address Line | 917 RINEHART RD SUITE 1001
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City | LAKE MARY
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State | FL
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Zip | 32746-4802
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Country | US
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Telephone | 407-708-5383
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Fax | 407-708-5396
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CHERYL M. MODICA
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Credential | RN,LHRM
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Telephone | 407-708-5383
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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 | 1225
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License Number State | FL
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