MEDICARE: VIP SURGERY CENTER-LAKELAND 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

General Provider Information

NPI Number	:	1780060103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP SURGERY CENTER-LAKELAND INC

Provider Business Mailing Address
First Line	:	3035 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2201
Country	:	US
Telephone Number	:	863-577-8246
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2201
Country	:	US
Telephone Number	:	863-577-8246
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MEDICAL DIRECTOR
Name	:	DR. OBINNA NWOBI
Credential	:	M.D.
Telephone Number	:	863-577-8246

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	08/07/2015

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