MEDICARE: SEBRING VASCULAR SURGERY PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	ME85381	FL

General Provider Information

NPI Number	:	1417142035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEBRING VASCULAR SURGERY PL

Provider Business Mailing Address
First Line	:	3323 MEDICAL HILL RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-5531
Country	:	US
Telephone Number	:	863-382-2361
Fax Number	:	863-382-4327

Provider Business Practice Location Address
First Line	:	3323 MEDICAL HILL RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-5531
Country	:	US
Telephone Number	:	863-382-2361
Fax Number	:	863-382-4327

Authorized Official
Title or Position	:	PREISDENT
Name	:	DR. PATRICIO ROSA
Credential	:	MD
Telephone Number	:	863-382-2361

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	04/15/2008

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