MEDICARE: GEMINI AMBULATORY SURGICAL CENTER INCORPORATED

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	:	1780292359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEMINI AMBULATORY SURGICAL CENTER INCORPORATED

Provider Business Mailing Address
First Line	:	7661 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-432-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	7661 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-432-4141
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONIQUE BARBOUR
Credential	:	MD
Telephone Number	:	561-432-4141

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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