MEDICARE: MUSCULOSKELETAL AMBULATORY SURGERY CENTER, INC.

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	1314	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
2	6AA	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1760627830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSCULOSKELETAL AMBULATORY SURGERY CENTER, INC.

Provider Business Mailing Address
First Line	:	6015 POINTE WEST BLVD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5532
Country	:	US
Telephone Number	:	941-782-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 WORTH CT
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-2110
Country	:	US
Telephone Number	:	941-782-0101
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL M DUCK
Credential	:
Telephone Number	:	941-792-1404

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	07/21/2010

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