MEDICARE: SURGICAL SERVICE CLINICS 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	261Q00000X	Clinic/Center		FL

General Provider Information

NPI Number	:	1922338847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SERVICE CLINICS INC

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IVAN GARCIA
Credential	:
Telephone Number	:	305-262-3999

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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