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NPI Code Detail

MEDICARE: SPACE COAST SURGICAL CENTER LTD

MEDICARE: SPACE COAST SURGICAL CENTER LTD
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
1261QA1903XAmbulatory Surgical Clinic/Center984FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437112455
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPACE COAST SURGICAL CENTER LTD
Provider Business Mailing Address
First Line : 220 N SYKES CREEK PKWY
Second Line : SUITE 101
City : MERRITT ISLAND
State : FL
Zip : 32953-3490
Country : US
Telephone Number : 321-459-0015
Fax Number : 321-459-2291
Provider Business Practice Location Address
First Line : 220 N SYKES CREEK PKWY
Second Line : SUITE 101
City : MERRITT ISLAND
State : FL
Zip : 32953-3490
Country : US
Telephone Number : 321-459-0015
Fax Number : 321-459-2291
Authorized Official
Title or Position : ADMINISTRATOR
Name : CYNTHIA A JOHNSON
Credential :
Telephone Number : 321-459-0015
Provider Enumeration Date : 04/10/2006
Last Update Date : 03/28/2016

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1134112303 — ANABEL P PEREDA APRN
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Directions to “SPACE COAST SURGICAL CENTER LTD ” Practice Location

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