MEDICARE: IQUEST SURGERY CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center	ME 97267	GA

General Provider Information

NPI Number	:	1457605917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IQUEST SURGERY CENTER

Provider Business Mailing Address
First Line	:	1738 W 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3456
Country	:	US
Telephone Number	:	305-819-8841
Fax Number	:	305-819-6866

Provider Business Practice Location Address
First Line	:	1738 W 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3456
Country	:	US
Telephone Number	:	305-819-8841
Fax Number	:	305-819-6866

Authorized Official
Title or Position	:	VICEPRESIDENT
Name	:	DR. YESIM ESTHER CALAFELL
Credential	:	M.D.
Telephone Number	:	305-819-8841

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	11/06/2012

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