MEDICARE: SURGERY CENTER OF CORAL GABLES, LLC

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	1163	FL

General Provider Information

NPI Number	:	1588669204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF CORAL GABLES, LLC

Provider Business Mailing Address
First Line	:	2645 DOUGLAS ROAD
Second Line	:	SUITE 400
City	:	MIAMI
State	:	FL
Zip	:	33133-2744
Country	:	US
Telephone Number	:	305-461-3229
Fax Number	:	305-461-3288

Provider Business Practice Location Address
First Line	:	2645 DOUGLAS ROAD
Second Line	:	SUITE 400
City	:	MIAMI
State	:	FL
Zip	:	33133-2744
Country	:	US
Telephone Number	:	305-461-3229
Fax Number	:	305-461-3288

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JAMES SEYMOUR
Credential	:	CASC
Telephone Number	:	305-461-3229

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	03/06/2008

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