MEDICARE: BETHESDA OUTPATIENT SURGERY 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	282N00000X	General Acute Care Hospital
2	261QA1903X	Ambulatory Surgical Clinic/Center	935	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1750364634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA OUTPATIENT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 628762
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32862-8762
Country	:	US
Telephone Number	:	813-549-2134
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 S DIXIE HIGHWAY SUITE 101
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-3724
Country	:	US
Telephone Number	:	561-374-5550
Fax Number	:	561-374-9977

Authorized Official
Title or Position	:	CHIEF ADMININISTRATIVE OFFICER
Name	:	TRACIE GARI
Credential	:
Telephone Number	:	813-549-2134

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	09/20/2025

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