MEDICARE: CYPRESS CREEK OUTPATIENT SURGICAL CENTER, 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		FL

General Provider Information

NPI Number	:	1679086078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS CREEK OUTPATIENT SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2122 W CYPRESS CREEK RD STE 120
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-1866
Country	:	US
Telephone Number	:	954-900-3382
Fax Number	:	954-368-9625

Provider Business Practice Location Address
First Line	:	CYPRESS CREEK OUTPATIENT SURGICAL CENTER, LLC
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33309-1829
Country	:	US
Telephone Number	:	954-986-7079
Fax Number	:	954-986-1331

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LILIANA LEHMANN
Credential	:	MBA
Telephone Number	:	954-900-3382

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	07/14/2022

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