MEDICARE: SURGICAL SERVICE OF DADE COUNTY CORP

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	174400000X	Specialist	ME67164	FL

General Provider Information

NPI Number	:	1881791341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SERVICE OF DADE COUNTY CORP

Provider Business Mailing Address
First Line	:	1165 W 49TH ST STE 208
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3373
Country	:	US
Telephone Number	:	305-512-5480
Fax Number	:	305-512-5489

Provider Business Practice Location Address
First Line	:	1165 W 49TH ST STE 208
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3373
Country	:	US
Telephone Number	:	305-512-5480
Fax Number	:	305-512-5489

Authorized Official
Title or Position	:	PHYSICIAN CONSULTANT
Name	:	MRS. LAURA LEIVA
Credential	:
Telephone Number	:	305-458-9895

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	12/05/2008

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