MEDICARE: CENTER OF SURGICAL EXCELLENCE OF VENICE FLORIDA LLC

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	990010084736	FL

General Provider Information

NPI Number	:	1952354326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER OF SURGICAL EXCELLENCE OF VENICE FLORIDA LLC

Provider Business Mailing Address
First Line	:	8421 POINTE LOOP DR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2232
Country	:	US
Telephone Number	:	941-412-2100
Fax Number	:	941-412-2160

Provider Business Practice Location Address
First Line	:	8421 POINTE LOOP DR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2232
Country	:	US
Telephone Number	:	941-270-2744
Fax Number	:	941-412-2160

Authorized Official
Title or Position	:	ADMINISTRATOR,PRESIDENT
Name	:	DR. JAFFER J. KHAN
Credential	:	M.D.
Telephone Number	:	941-412-2100

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/25/2016

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